Trial Finds a Cheaper Imaging Scan Works as Well for Tricky Heart Stenting

A randomised trial has found that optical coherence tomography (OCT), a scanning technique that gives a high-resolution view inside a blood vessel, is not inferior to intravascular ultrasound (IVUS) for guiding stent placement in one of the heart's most technically demanding arteries. The results were presented in a Hot Line session at the ESC Congress 2026, a European cardiology conference.

Percutaneous coronary intervention (PCI), a procedure that widens narrowed heart arteries and holds them open with a stent, is especially demanding in the left main coronary artery, which supplies most of the blood to the heart's left ventricle, particularly where the artery splits into two branches. IVUS gives good tissue penetration and a wide field of view, while OCT gives a higher-resolution look at the vessel wall and the stent itself, but until now there was no dedicated randomised comparison of the two methods for this specific type of lesion.

The ISOLEDS trial, led by Yong Zeng of Beijing Anzhen Hospital, Capital Medical University, enrolled 664 patients with these bifurcation lesions at 24 centres in China. Patients were randomly split evenly between OCT-guided and IVUS-guided stenting. The average patient age was 63.5 years, and 22.1 per cent were women.

At a median follow-up of 362 days, target lesion failure, a combined measure of cardiac death, heart attack linked to the treated artery, or a repeat procedure on it, occurred in 14.4 per cent of the OCT group compared with 19.6 per cent of the IVUS group, meeting the trial's threshold for OCT to be considered not inferior to IVUS.

Zeng said the findings show OCT guidance may be considered an alternative to IVUS guidance for appropriately selected patients undergoing this type of procedure, but cautioned that the trial does not establish that either technique is equivalent to or better than the other, and that choosing between them in practice should depend on the artery's anatomy, how easy it is to get a clear image, and the operating team's experience with each method.