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Intravascular Imaging for Guiding Stent Implantation Ensures Safer Stenting Procedures

By MedImaging International staff writers
Posted on 16 Apr 2025

Patients diagnosed with coronary artery disease, which is caused by plaque accumulation within the arteries leading to chest pain, shortness of breath, and potential heart attacks, frequently undergo percutaneous coronary intervention (PCI). More...

This non-surgical procedure involves the insertion of a catheter by interventional cardiologists to place stents in blocked coronary arteries, thereby restoring blood flow. Approximately one-third of these cases in the United States, which amounts to hundreds of thousands annually, involve moderate to severe calcified lesions, where calcium accumulates within the arteries. Around 10% of these cases are categorized as severe, where the arteries essentially turn to bone, making the stenting procedure more complex and risky. Typically, interventional cardiologists use angiography to guide the PCI catheter, which involves injecting a special dye and using X-rays to visualize blood flow through the heart arteries, helping to highlight blockages.

However, angiography has inherent limitations, such as its inability to accurately assess the true size of the arteries and the composition of the plaque, and its shortcomings in determining whether the stent is fully expanded after PCI. Angiography also struggles to identify other complications that might affect the safety and effectiveness of the procedure. These challenges are amplified when dealing with calcified coronary arteries. New research now shows that using intravascular imaging (IVI) to guide stent implantation during complex stenting procedures provides a safer and more effective solution for patients with severely calcified coronary artery disease compared to traditional angiography. These findings come from the largest clinical trial of its kind, which compared the two methods during PCI.

The ECLIPSE study, funded by Abbott Vascular, Inc. (Santa Clara, CA, USA) and led by Mount Sinai Health System (New York, NY, USA), analyzed the outcomes of PCI in patients with severely calcified lesions, involving 2,005 participants. The goal was to assess whether IVI guidance could improve survival rates free from adverse cardiac events when compared to angiography. Patients with severely calcified coronary lesions were randomized at 104 sites across the U.S. One group of 1,246 patients, or 62%, underwent PCI with guidance from either optical coherence tomography (OCT) or intravascular ultrasound (IVUS), while 759 patients, or 38%, had PCI guided by angiography. The primary endpoint was the one-year rate of target vessel failure, which included cardiac death, target-vessel myocardial infarction, or ischemia-driven target-vessel revascularization.

The results showed that overall rates of target vessel failure were 26% lower in patients who received IVI guidance compared to those who underwent angiography guidance. Additionally, there was a significant reduction in all-cause death, stent thrombosis, and revascularization of target lesions and vessels among those treated with intravascular imaging compared to angiography. Further analysis of the two imaging modalities—IVUS and OCT—was conducted to determine which was more effective. The unadjusted analysis revealed that patients with OCT guidance had better outcomes than those with IVUS; however, when adjusting for factors such as age, diabetes, and the number and severity of lesions, the differences were not statistically significant.

OCT and IVUS provide detailed, high-resolution images of the coronary arteries and blockages, offering a more accurate and specific view than traditional coronary angiography. These imaging techniques also enable a better assessment of the adequacy of the implanted stent. Both imaging methods help in more accurately measuring the dimensions and composition of the vessel and plaque and in better assessing the quality of stent implantation. The findings from the ECLIPSE trial, presented at the American College of Cardiology Scientific Session (ACC.25), could lead to significant changes in treatment strategies for high-risk patients.

“The ECLIPSE trial shows that use of IVI to guide coronary stenting in severely calcified lesions prevents death, stent thrombosis, and unplanned repeat procedures in this high-risk patient population,” said first author Gregg W. Stone, MD. “These results extend the strong recommendations from recent U.S. and European societal guidelines that intravascular imaging with either optical coherence tomography (OCT) or intravascular ultrasound (IVUS) should be routinely used during complex coronary stent procedures.”

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59 (64.849853515625): SELECT fid FROM jos_deeppockets WHERE id=294804678 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294804678 AND published='1' LIMIT 1

60 (46.968460083008): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=214 ORDER BY `ordering`

61 (262.02201843262): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294804678 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

62 (!!!!! 1317.9779052734): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

63 (126.83868408203): SELECT show_live FROM jos_com_show_setting LIMIT 1

64 (51.975250244141): SELECT show_live FROM jos_com_show_setting LIMIT 1

65 (43.869018554688): SELECT show_live FROM jos_com_show_setting LIMIT 1

66 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

67 (42.915344238281): SELECT show_live FROM jos_com_show_setting LIMIT 1

68 (158.07151794434): SELECT show_live FROM jos_com_show_setting LIMIT 1

69 (42.915344238281): SELECT show_live FROM jos_com_show_setting LIMIT 1

70 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

71 (43.153762817383): SELECT show_live FROM jos_com_show_setting LIMIT 1

72 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

73 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (97.036361694336): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294804678 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

78 (37.908554077148): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

79 (77.009201049805): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (44.107437133789): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (44.107437133789): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (699.99694824219): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (643.96858215332): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (123.97766113281): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (52.928924560547): SELECT show_live FROM jos_com_show_setting LIMIT 1

89 (224.11346435547): SELECT show_live FROM jos_com_show_setting LIMIT 1

90 (74.148178100586): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (71.048736572266): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (66.041946411133): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (190.01960754395): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294804678 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294804678 AND published='1' LIMIT 1

94 (92.983245849609): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294804678 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294804678 AND published='1' LIMIT 1

95 (169.03877258301): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294804678 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

96 (!!!!! 3620.1477050781): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294804678 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294804678 AND published='1' LIMIT 1

97 (237.94174194336): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294804678 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294804678 AND published='1' LIMIT 1

98 (520.94459533691): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294804678 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

99 (366.2109375): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294804675 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

100 (796.07963562012): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

101 (571.96617126465): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

102 (161.17095947266): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294804678 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294804678 AND published='1' LIMIT 1

103 (61.03515625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294804678 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294804678 AND published='1' LIMIT 1

104 (82.015991210938): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294804678 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294804678 AND published='1' LIMIT 1

105 (56.028366088867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294804678 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294804678 AND published='1' LIMIT 1

106 (71.048736572266): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294804678 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294804678 AND published='1' LIMIT 1

107 (45.061111450195): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294804678 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294804678 AND published='1' LIMIT 1

108 (66.041946411133): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294804678 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294804678 AND published='1' LIMIT 1

109 (46.014785766602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294804678 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294804678 AND published='1' LIMIT 1

110 (483.03604125977): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

111 (!!!!! 26145.935058594): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

112 (673.05564880371): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294804678 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294804678 AND type='deeppockets_item' AND published='1' LIMIT 1

113 (!!!!! 9073.9727020264): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

114 (104.90417480469): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

115 (313.04359436035): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

116 (123.02398681641): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

117 (341.17698669434): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

118 (55.074691772461): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

119 (46.968460083008): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

120 (42.200088500977): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

121 (239.13383483887): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

122 (53.882598876953): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

123 (396.0132598877): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294804678 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

124 (200.03318786621): SELECT name FROM jos_deeppockets WHERE id=214

125 (49.114227294922): SELECT name FROM jos_deeppockets WHERE id=214

126 (844.00177001953): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))214((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

127 (780.10559082031): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))214((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

128 (115.87142944336): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294804678 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294804678 AND published='1' LIMIT 1

129 (68.187713623047): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294804678 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294804678 AND published='1' LIMIT 1

130 (!!!!! 16241.073608398): TRUNCATE TABLE jos_trademed_module

131 (174.99923706055): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294804678 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

132 (832.08084106445): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294804678 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

133 (103.95050048828): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294804678 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

134 (104.90417480469): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294804678 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294804678 AND published='1' LIMIT 1

135 (86.069107055664): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294804678 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294804678 AND published='1' LIMIT 1

136 (!!!!! 1878.023147583): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

137 (112.77198791504): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294804678 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294804678 AND published='1' LIMIT 1

138 (83.92333984375): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294804678 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294804678 AND published='1' LIMIT 1

139 (78.916549682617): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294804678 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294804678 AND type='deeppockets_item' AND published='1' LIMIT 1

140 (51.021575927734): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=0 or channel_id is null)

141 (46.968460083008): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=0 or channel_id is null)

142 (70.095062255859): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

143 (213.1462097168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294804678 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294804678 AND published='1' LIMIT 1

144 (406.02684020996): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294804678 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294804678 AND published='1' LIMIT 1

145 (159.02519226074): select jos_twitters.link from jos_twitters where cat=10

146 (45.061111450195): select jos_facebook.link from jos_facebook where cat=10

147 (44.822692871094): select jos_google_plus.link from jos_google_plus where cat=10

148 (37.908554077148): select jos_linkedin.link from jos_linkedin where cat=10

149 (295.16220092773): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14202,14203)

150 (!!!!! 1600.980758667): insert into jos_banners_delta values (14202,'2025-08-01 22:23:05','216.73.216.210','view'),(14203,'2025-08-01 22:23:05','216.73.216.210','view')

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