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Related Experiment Video

Updated: May 3, 2026

Imaging In-Stent Restenosis: An Inexpensive, Reliable, and Rapid Preclinical Model
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Network Meta-Analysis of Two Methods of Stent Optimisation Using Intravascular Imaging During Percutaneous Coronary

Scott Kinlay1, Joanne R Kinlay2

  • 1Cardiovascular Division, Department of Medicine, VA Boston Healthcare System, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Cardiovascular Division, Department of Medicine, Massachusetts General Brigham Hospital, Boston, MA, USA.

Heart, Lung & Circulation
|May 1, 2026
PubMed
Summary

Optimizing stent placement using the reference lumen method during percutaneous coronary intervention (PCI) with intravascular imaging is linked to fewer major adverse cardiovascular events (MACE). Stenting to external elastic lamina (EEL) dimensions increased MACE risk.

Keywords:
Drug-eluting stentsExternal elastic laminaIntravascular ultrasoundLumenOptical coherence tomographyOutcomes

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Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Imaging

Background:

  • Percutaneous coronary intervention (PCI) utilizes intravascular imaging (IVUS/OCT) to reduce major adverse cardiovascular events (MACE) versus angiography alone.
  • Optimal stent sizing strategy (reference lumen vs. external elastic lamina) remains unclear.
  • This study compares MACE rates following PCI optimized to reference lumen versus EEL dimensions.

Purpose of the Study:

  • To compare the incidence of MACE after PCI when stents are optimized to reference lumen versus EEL dimensions.
  • To evaluate secondary endpoints including myocardial infarction (MI), repeat revascularization, and cardiac death.

Main Methods:

  • A network meta-analysis of 17 randomized controlled trials involving 16,069 patients undergoing PCI with drug-eluting stents was performed.
  • Pooled relative risks (RRs) and 95% confidence intervals (CIs) for MACE and secondary endpoints were estimated, standardized to 2-year follow-up.
  • Meta-regression was used to identify potential effect modifiers and interactions.

Main Results:

  • Both reference lumen and EEL optimization reduced MACE compared to angiography alone.
  • The EEL method resulted in significantly higher MACE (RR 1.36; 95% CI 1.13-1.63) compared to the reference lumen method, primarily driven by increased MI risk (RR 1.37; 95% CI 1.06-1.78).
  • Intravascular imaging improved MACE over angiography alone only in complex PCI or with long stents (>25 mm).

Conclusions:

  • Optimizing stent deployment to reference lumen dimensions using intravascular imaging may improve outcomes after PCI.
  • Further research is needed to directly compare the reference lumen and EEL intravascular imaging algorithms.