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Updated: May 3, 2026
Imaging In-Stent Restenosis: An Inexpensive, Reliable, and Rapid Preclinical Model
Published on: September 14, 2009
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.
Background:
Percutaneous coronary intervention (PCI) guided by intravascular imaging using either intravascular ultrasound (IVUS) or optical coherence tomography (OCT) decreases the risk of major adverse cardiovascular events (MACE) compared to angiography alone. However, it is uncertain whether to optimise the stent to the reference lumen or the external elastic lamina (EEL) dimensions. We compared MACE after PCI optimised to the reference lumen or the EEL dimensions. Secondary endpoints assessed the risk of myocardial infarction (MI), repeat revascularisation, and cardiac death.
Method:
We searched databases for randomised controlled trials of PCI with drug-eluting stents guided by intravascular imaging with either the reference lumen or the EEL to angiography alone or directly to each other. Network meta-analysis using random effects models estimated pooled relative risks (RRs) and 95% confidence intervals (CIs) for the risk of MACE and the secondary endpoints using incidence rates standardised to 2 years of follow-up. Meta-regression assessed potential effect modifiers and interactions.
Results:
We identified 17 randomised trials of 16,069 subjects with MACE determined over a median 2 years. Both the EEL and reference lumen methods of stent optimisation decreased the risk of MACE compared to angiography alone. However, compared to the reference lumen method the EEL method had significantly higher MACE (RR 1.36; 95% CI 1.13-1.63), driven by higher risks of MI (RR 1.37; 95% CI 1.06-1.78). Subgroup analyses showed intravascular imaging improved MACE over angiography alone only in complex PCI or with the use of long stents (>25 mm). Meta-regression models found no evidence of effect modifiers, interaction between IVUS vs OCT and the optimisation method, or small-study effects.
Conclusions:
Using the reference lumen method from intravascular imaging to optimise stent deployment may lead to better outcomes after PCI. Future studies should compare the two intravascular imaging algorithms directly.
