Current Practice Patterns and Barriers to Intravascular Imaging-Guided Percutaneous Interventions: Insights from a...

Despite robust evidence supporting use of intravascular imaging (IVI) to guide complex percutaneous coronary intervention (PCI), its adoption across Canada remains poorly defined.

A standardized cross-sectional electronic survey was distributed to catheterization laboratory directors across Canada.

Sites were evenly distributed between academic (9; 43%) and nonacademic (12; 57%) institutions, with a mean annual PCI volume of 1706 ± 722 procedures. IVI integration into the catheterization laboratory was reported in 38 of 56 laboratories (68%), with a median of 6 PCI operators (interquartile range, 5-9) per site. Operator comfort levels were generally good, with the majority of catheterization laboratory directors describing their operators as being somewhat experienced (6; 29%) or very experienced (9; 43%). Most directors (90%) perceived IVI as having a positive impact on outcomes. Overall, results showed a trend toward an increase in IVI-guided PCI between 2022 and 2024 (15.6% vs 19.1%, P = 0.7). The most-cited barriers to broader IVI use were increased procedure time (76%), cost of equipment or devices (67%), and reimbursement challenges (48%), with no differences between Ontario and non-Ontario sites (40% vs 33%, P = 1.0). Over half (52%) of centres were planning to complete IVI upgrades within the next 2 years.

Although IVI is widely available in Canadian catheterization laboratories, it remains underused, due to barriers related to procedure time, workflow, and cost. A coordinated effort among key stakeholders is needed to reduce current barriers and promote broader guideline-concordant use and IVI adoption.