Proportion and Clinical Impact of Stent Optimization During Intravascular Imaging-Guided Percutaneous Coronary Intervention (JACC Cardiovascular Interventions May 2025)-Article: Proportion and Clinical Impact of Stent Optimization During Intravascular Imaging-Guided Percutaneous Coronary Intervention

Article: Proportion and Clinical Impact of Stent Optimization During Intravascular Imaging-Guided Percutaneous Coronary Intervention

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The OCTIVUS trial, a study comparing the efficacy of Optical Coherence Tomography (OCT) and Intravascular Ultrasound (IVUS) in guiding Percutaneous Coronary Intervention (PCI), examines the extent of stent optimization and its clinical outcomes. Despite advancements in intravascular imaging, only about half of the 1,980 patients achieved stent optimization, as determined by meeting specific criteria after stent deployment. The study found a greater number of patients achieved optimization with IVUS than with OCT (54.8% vs. 48.3%), but overall, optimized patients had significantly lower target vessel failure (TVF) rates: 3.8% in the optimized group versus 7.5% in the nonoptimized group. This difference was even more pronounced in OCT-guided PCI.<br /><br />Stent optimization led to a reduced risk of TVF events, a composite endpoint including cardiac death, target vessel myocardial infarction, or revascularization, indicating better clinical outcomes with proper stent expansion and positioning. Multiple anatomical and clinical factors, such as complex coronary lesions measured by higher SYNTAX scores and extensive lesion length, were associated with failed stent optimization, highlighting the procedural challenges in achieving optimal results.<br /><br />Procedural improvements like effective lesion preparation and appropriate balloon sizing were linked to increased success in achieving optimization. Given the disparities in optimization rates, this trial emphasizes the importance of implementing standard, effective intravascular imaging criteria and strategies to optimize stent placement, potentially enhancing patient outcomes post-PCI. Further research is needed to refine these criteria and adapt them more broadly in clinical practice to ensure improved cardiovascular outcomes for patients undergoing PCI, especially in complex cases.

Keywords

OCTIVUS trial

Optical Coherence Tomography

Intravascular Ultrasound

Percutaneous Coronary Intervention

stent optimization

target vessel failure

clinical outcomes

SYNTAX scores

lesion preparation

cardiovascular outcomes