Implementing Intravascular Imaging–Guided Percutaneous Coronary Intervention: A Scoping Review Using the Consolidated Framework for Implementation Research

Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) can improve percutaneous coronary intervention (PCI) by refining the sizing, lesion preparation, and stent optimization; however, their adoption varies widely across health systems. Map determinants, strategies, and implementation outcomes for IVUS/OCT-guided PCI using the Consolidated Framework for Implementation Research (CFIR) and Proctor's taxonomy. Map determinants, strategies, and implementation outcomes for IVUS/OCT-guided PCI using the Consolidated Framework for Implementation Research (CFIR) and Proctor's taxonomy. We conducted a PRISMA-ScR-aligned scoping review through March 15, 2025. Eligible primary studies (randomized trials, pre-specified substudies, registries, and prospective cohorts) evaluated IVUS and/or OCT during PCI and reported at least one CFIR determinant or one Proctor outcome (adoption/penetration, feasibility, fidelity, sustainability, and cost). Two reviewers screened and charted the data in duplicate, and the clinical outcomes were treated as contextual. We narratively synthesized the findings and organized them by era, modality, and policy setting. From 1218 records, 17 studies were included (14 primary and 3 contextual/workflow sources). The recurrent facilitators were explicit quantitative optimization thresholds, protocolized use, operator training/mentorship, and audit/feedback. Policy/reimbursement consistently enabled higher penetration and sustained usage. Minimal-contrast IVUS protocols are feasible in high-risk cohorts, achieving large reductions in contrast without compromising the procedural success. Quantitative expansion indices (e.g., minimal stent area or area-based expansion) functioned as fidelity targets and were associated with clinical events across data sets. Cost signals were nuanced; early randomized economics favored IVUS-guided strategies via fewer reinterventions and lower cumulative costs, whereas physiology-first strategies were more efficient than OCT-first strategies for intermediate lesions. Successful imaging programs appear bundle-dependent: pairing access to IVUS/OCT with explicit thresholds, standardized pre-/post-deployment runs, team training, and feedback within supportive policies yields more reliable performance and scalable value. Priorities include hybrid effectiveness-implementation studies, standardized fidelity dashboards, cross-vendor validation of thresholds, equity-minded rollout pathways, and prospective evaluation of AI-enabled OCT to test whether workflow gains translate into patient benefits.