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

Abstract

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 (P < 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.