Use of Intravascular Imaging to Guide Percutaneous Coronary Interventions: Experience from a Single, High-Volume Canadian Centre

Background: Intravascular imaging (IVI) improves outcomes in complex percutaneous coronary intervention (PCI) and is recommended by the latest guidelines.However, data about its real-world application remains limited.Methods: We conducted a retrospective audit of 300 consecutive PCI cases.Lesions were classified as complex if they involved >1 following characteristics: bifurcation, severe calcifications, CTO, long lesions, ostial location and involvement of the LM.IVI use was analyzed by lesion subtype and individual operator.Results: Of 300 consecutive PCI cases, 146 (49%) were classified as complex PCI.IVI was used in 53% of complex PCIs and 23% of noncomplex PCIs.Among patients undergoing complex PCI, IVI was most frequently performed in CTOs (86%) and LM (76%), but its use remained below 50% for bifurcations, severe calcified and long lesions.IVI-guided PCI was associated with higher contrast use (215 78 mL vs. 179 65 mL, P = 0.003) and longer procedural duration (72 32 minutes vs. 51 22 minutes, P < 0.001) and varied widely across operators, ranging from 0-79% in the overall population (p<0.001) to 0-90% in complex lesions (p=0.004).Notably, IVI adoption declined with increasing operator age (OR 0.88 per +1 year; 95% CI 0.78-0.98),whereas it increased with lesion complexity (OR 2.34 per additional complexity feature; 95% CI 1 1.62-3.39).Conclusions: Despite current evidence and guideline recommendations, IVI use showed notable variation across operators.Standardizing IVI utilization through education, protocols, and systemlevel support will be essential to promote guideline-concordant practice.