IVUS is not simply “better imaging” — this review shows where intravascular ultrasound changes real outcomes: complex coronary PCI, long lesions, diabetic ACS, femoropopliteal intervention, and iliofemoral venous disease. The full paper is worth reading because it maps when IVUS should be selectively adopted, when routine use adds little, and where AI-driven and hybrid intravascular imaging may define the next generation of endovascular precision.
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Abstract: To synthesize current evidence regarding the diagnostic utility, procedural impact, and clinical outcomes of IVUS-guided interventions in coronary, peripheral, and venous vascular territories. The review utilises 2396 original studies with 6000754 total participants (topic deduplicated ΣN). The mapped evidence indicates that intravascular ultrasound guidance is associated with improved procedural and clinical outcomes across coronary, peripheral, and venous territories, with the most prominent randomized coronary signals including lower 12-month target vessel failure in diabetic acute coronary syndrome patients (3.6% versus 8.3%), lower 5-year major adverse cardiac events in long coronary lesions (5.6% versus 10.7%), and lower 3-year target vessel failure in all-comer DES PCI (6.6% versus 10.7%). Recurrent topic-level signals support intravascular ultrasound for left main, long-lesion, bifurcation, and chronic total occlusion percutaneous coronary intervention, while serial intravascular ultrasound consistently functioned as a quantitative endpoint for atheroma regression and post-stent optimization metrics such as minimum stent area greater than 5.5 mm² predicted favorable outcomes. In peripheral and venous disease, intravascular ultrasound was associated with higher 24-month freedom from target lesion revascularization in femoropopliteal drug-coated balloon angioplasty (87.4% vs 78.0%), detection of iliofemoral lesions missed by venography in approximately 26% of cases, and improved patency after iliofemoral venous stenting. The evidence map also highlights heterogeneity, with neutral findings in non-complex, short-lesion, aortoiliac claudication, and unprotected left main settings, suggesting that clinical benefit is concentrated in anatomically or clinically complex subsets rather than uniform routine use. Practically, these signals support selective adoption of intravascular ultrasound in complex percutaneous coronary intervention, iliofemoral venous intervention, and cardiac allograft vasculopathy surveillance, while emerging hybrid imaging, artificial intelligence-assisted segmentation, and intravascular ultrasound-derived virtual physiology represent promising adjuncts. Future research should prioritize adequately powered randomized trials in lower-complexity coronary lesions, peripheral claudication, and idiopathic intracranial hypertension venous sinus stenting, alongside standardization of optimization thresholds and head-to-head comparisons with optical coherence tomography in calcified disease.
Final search date and database lock: 2026-04-27 20:59:06 CEST
Plan: Pro (expanded craft tokens; source: PubMed)
Source: PubMed
Total Abstracts/Papers: 6148
Downloaded Abstracts/Papers: 3400
Included original and non-original Abstracts/Papers (all): 2719
Included original Abstracts/Papers (Vote counting by direction of effect): 2396
Reference Index (links used in paper): 215
Total participants (topic deduplicated ΣN): 6000754
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[2453] Diagnostic performance of intravascular ultrasound-based fractional flow reserve in evaluating of intermediate left main stenosis. — https://doi.org/10.26599/1671-5411.2024.01.003
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[2507] Patterns of Coronary Calcification and Their Impact on the Diagnostic Accuracy of Computed Tomography Coronary Angiography. — https://doi.org/10.1097/rct.0000000000000681
[2626] Use of Intravascular Ultrasound to Improve Diagnosis and Treatment of Transjugular Intrahepatic Portosystemic Shunt Dysfunction in Patients in the Long-term Follow-up. — https://doi.org/10.5005/jp-journals-10018-1374
[2640] Intravascular ultrasound findings of early stent thrombosis after primary percutaneous intervention in acute myocardial infarction: a Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) substudy. — https://doi.org/10.1161/circinterventions.110.959791
[2656] Primary Use of the TruePath Crossing Device for Infrainguinal Chronic Total Occlusions With Intravascular Ultrasound Evaluation. — https://doi.org/10.1177/1526602818793901
[2711] Impact of lipid-lowering therapy with pitavastatin, a new HMG-CoA reductase inhibitor, on regression of coronary atherosclerotic plaque. — https://doi.org/10.1253/circj.71.1678