Abstract Background In-stent restenosis remains a recognized complication of percutaneous coronary intervention (PCI). Conventional two-dimensional angiography is limited to visualization of the coronary lumen and provides inadequate assessment of in-stent restenosis mechanisms. In contrast, intracoronary imaging modalities such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT) enable detailed evaluation of in-stent restenosis, optimization of procedural outcomes, and improvement of long-term clinical results. Aims The aim of this study was to compare OCT and IVUS in detecting the mechanisms of in-stent restenosis and to evaluate their role in guiding management, whether through balloon angioplasty or repeat PCI with stent implantation. Materials and methods The study included 50 patients who had previously deployed stents presenting to our hospital, in the period from November 2022 to December 2024, with angina refractory to medical therapy. All of whom underwent comprehensive clinical evaluation including history, physical examination, ECG, echocardiography, and coronary angiography. Patients were divided randomly into two groups: Group 1 (n=25) underwent IVUS-guided PCI, while Group 2 (n=25) underwent OCT-guided PCI. Results OCT was significantly superior to IVUS in detecting mal-apposition (p = 0.015) and neo-atherosclerosis (p = 0.018) as mechanisms of in-stent restenosis. No statistically significant differences were observed between OCT and IVUS in detecting neointimal hyperplasia (p = 0.713), under-expansion (p = 0.077), or edge dissection (p = 0.269). Conclusion Intracoronary imaging is a valuable tool for identifying the mechanisms of in-stent restenosis, guiding tailored therapy, and improving clinical outcomes. OCT offers superior diagnostic capability compared with IVUS, particularly in detecting mal-apposition and neo-atherosclerosis.
Saad et al. (Thu,) studied this question.