Use of Intravascular Imaging to Guide Percutaneous Coronary Interventions: A Single-Center Experience from a High-Volume Canadian Centre

Background Intravascular imaging (IVI) improves outcomes in complex percutaneous coronary intervention (PCI) and is recommended by the latest guidelines. However, data about its real-world application remains limited. Methods We conducted a retrospective audit of 300 consecutive PCI cases. Lesions were classified as complex if they involved >1 following characteristics: bifurcation, severe calcifications, CTO, long lesions, ostial location and involvement of the LM. IVI use was analyzed by lesion subtype and individual operator. Results Of 300 consecutive PCI cases, 146 (49%) were classified as complex PCI. IVI was used in 53% of complex PCIs and 23% of noncomplex PCIs. Among patients undergoing complex PCI, IVI was most frequently performed in CTOs (86%) and LM (76%), but its use remained below 50% for bifurcations, severe calcified and long lesions. IVI-guided PCI was associated with higher contrast use (215 ± 78 mL vs. 179 ± 65 mL, P = 0.003) and longer procedural duration (72 ± 32 minutes vs. 51 ± 22 minutes, P < 0.001) and varied widely across operators, ranging from 0-79% in the overall population (p<0.001) to 0-90% in complex lesions (p=0.004). Notably, IVI adoption declined with increasing operator age (OR 0.88 per +1 year; 95% CI 0.78–0.98), whereas it increased with lesion complexity (OR 2.34 per additional complexity feature; 95% CI 1 1.62–3.39). Conclusions Despite current evidence and guideline recommendations, IVI use showed notable variation across operators. Standardizing IVI utilization through education, protocols, and system-level support will be essential to promote guideline-concordant practice.