Advantages of hybrid intravascular ultrasound-optical coherence tomography system in clinical practice.

BACKGROUND

While the hybrid intravascular ultrasound-optical coherence tomography (IVUS-OCT) imaging system offers theoretical advantages for enhanced characterization of vascular morphology and histopathology through multimodal integration, its clinical efficacy lacks systematic validation. We conducted a comprehensive comparative analysis of this novel hybrid imaging modality against conventional single-modality OCT and IVUS systems, aiming to establish an evidence-based foundation for its clinical implementation and broader adoption in interventional cardiology practice.

OBJECTIVE

To evaluate the clinical advantages of hybrid intravascular ultrasound-optical coherence tomography (IVUS-OCT) system compared with single-modality imaging techniques in clinical practice.

METHODS

The hybrid IVUS-OCT intracoronary imaging system was employed to evaluate the characteristics of coronary atherosclerotic plaques and the immediate post-stent outcomes and compared against single-modality OCT and IVUS. The post-stent immediate effects were evaluated by the clear stent capture rate (CSCR), identification of incomplete stent apposition, tissue protrusion, and stent edge dissection.

RESULTS

74 patients underwent successful hybrid imaging (82 vessels imaged). Plaque analysis (23 vessels) identified 41 plaques [21 lipid, 20 calcified, 2 thin-cap fibroatheromas (TCFAs)]. OCT alone detected 21 lipid, 16 calcified, 3 possible TCFAs (maximal calcified arc accuracy: 68.75%). IVUS alone detected 15 lipid, 20 calcified, 0 TCFAs (maximal calcified arc accuracy: 85%). For post-stent evaluation (74 vessels), hybrid imaging visualized all stents (CSCR = 100%), detecting 23 incomplete stent apposition, 10 tissue protrusions, and 10 edge dissections. OCT detected 66 CSCR (89.19%), 23 incomplete stent apposition (100%), 10 tissue protrusions (100%), and 10 edge dissections (100%). IVUS detected 37 CSCR (50%), 8 incomplete stent apposition (34.78%), 2 tissue protrusions (20%), and 7 edge dissections (70%). Hybrid IVUS-OCT and OCT significantly outperformed IVUS in CSCR, tissue protrusion, and incomplete stent apposition detection ( < 0.05).

CONCLUSION

The hybrid IVUS-OCT intracoronary imaging system outperforms single-modality IVUS or OCT in evaluating coronary atherosclerotic plaque characteristics and immediate post-stent outcomes.