From the Guidelines
Intracoronary guided Percutaneous Coronary Intervention (PCI) is preferred over angiography guided PCI due to its ability to provide detailed cross-sectional views of coronary arteries, leading to improved clinical outcomes, particularly in complex lesions. The main difference between intra-coronary guided PCI and angiography guided PCI lies in the imaging techniques used during the procedure. Intra-coronary guided PCI utilizes advanced imaging technologies such as intravascular ultrasound (IVUS) or optical coherence tomography (OCT) to provide detailed cross-sectional views of coronary arteries from within the vessel itself, allowing for precise measurement of vessel dimensions, plaque composition, and stent deployment [ 1 ].
Key differences between the two techniques:
- Intra-coronary guided PCI offers superior visualization of vessel walls, plaque characteristics, and stent positioning, which can lead to more accurate stent sizing, better stent expansion, and reduced rates of stent malapposition.
- Angiography guided PCI relies solely on X-ray imaging with contrast dye to visualize the coronary arteries, providing only a two-dimensional silhouette of the vessel lumen.
- The use of intravascular imaging-guided PCI has been shown to lead to a lower risk of a composite of death from a cardiac cause, target vessel-related MI, or clinically driven target-vessel revascularization than angiography-guided PCI by 2 years [ 1 ].
Clinical implications:
- The decision between these techniques should be based on lesion complexity, patient characteristics, and institutional capabilities.
- Intra-coronary guided PCI requires additional equipment, expertise, procedure time, and cost compared to the more widely available angiography guided approach.
- Studies such as RENOVATE-COMPLEX PCI and OCTOBER have demonstrated the benefits of intravascular imaging-guided PCI, with reduced risks of adverse cardiac events [ 1 ].
From the Research
Difference between Intracoronary Guided PCI and Angiography Guided PCI
- The main difference between intracoronary guided Percutaneous Coronary Intervention (PCI) and angiography guided PCI is the use of imaging modalities to guide the procedure 2, 3, 4, 5, 6.
- Intracoronary imaging, such as Optical Coherence Tomography (OCT) or Intravascular Ultrasound (IVUS), provides detailed images of the coronary vessels, allowing for optimization of stent implantation and reduction of stent-related complications 3, 4, 5, 6.
- Angiography guided PCI, on the other hand, relies on X-ray imaging to visualize the coronary vessels, which may not provide sufficient detail to optimize stent implantation 2, 3, 4, 5.
Advantages of Intracoronary Guided PCI
- Intracoronary guided PCI has been shown to result in larger minimum stent areas and reduced risk of major adverse cardiovascular events (MACE) compared to angiography guided PCI 3, 4, 5.
- OCT-guided PCI has been shown to be non-inferior to IVUS-guided PCI and superior to angiography-guided PCI in terms of minimum stent area and MACE 3, 4.
- IVUS-guided PCI has been shown to reduce the risk of cardiovascular death, myocardial infarction, target lesion revascularization, and stent thrombosis compared to angiography-guided PCI 5.
Clinical Implications
- The use of intracoronary imaging to guide PCI has important clinical implications, including improved outcomes and reduced risk of complications 2, 3, 4, 5, 6.
- The choice of imaging modality, such as OCT or IVUS, depends on the specific clinical situation and the operator's preference 3, 4, 5, 6.
- Further research is needed to fully understand the benefits and limitations of intracoronary guided PCI and to establish its role in clinical practice 2, 3, 4, 5, 6.