Differences in OCT vs. IVUS-Guided PCI

This infographic provides a detailed comparison between Optical Coherence Tomography (OCT) and Intravascular Ultrasound (IVUS), two imaging modalities frequently used to guide percutaneous coronary intervention (PCI). It highlights key differences in technical aspects, clinical applications, imaging artifacts, and the latest guidelines.

Technical Differences

• OCT:
• Uses near-infrared light with high-resolution imaging (~10-20 µm).
• Requires contrast injection to clear blood for visualization, limiting its use in patients with renal dysfunction.
• Has a pullback speed up to 54 mm/s, allowing detailed imaging of microstructures.
• IVUS:
• Uses ultrasound with deeper tissue penetration (up to 10 mm).
• Does not require a bloodless field, making it ideal for heavily calcified lesions and complex anatomy.
• Better suited for larger coronary arteries and thrombus assessment.

Clinical Scenarios

• OCT:
• Best for detecting dissection, evaluating stent expansion, and identifying plaque microstructures.
• Provides superior imaging quality but requires good blood clearance and sufficient vessel size.
• IVUS:
• Preferred for assessing calcified plaques, thrombi, and evaluating bifurcations.
• Suitable for patients with chronic kidney disease (CKD) due to no contrast requirement.

Artifacts and Plaque Morphology

• OCT: Sensitive to bubble artifacts, saturation, and light scattering.
• IVUS: May experience nonuniform rotational distortion (NURD) and has limitations distinguishing between red and white thrombus.

Guidelines and Clinical Trials

• Both AHA/ACC/SCAI and ESC/EACTS guidelines recommend OCT and IVUS for optimizing stent placement, especially in complex lesions.
• Trials such as IVUS-XPL and ILUMIEN III support the effectiveness of IVUS in improving outcomes, with OCT offering advantages in stent optimization.

Produced by Adriana C. Mares
Reviewed by Dr. Abhinav Agarwal, Dr. Rawan Amir, Dr. Gurleen Kaur, Dr. Amit Goyal, Dr. Dan Ambinder, and Dr. Christine Shen

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