Ultrasound-guided Interventions Research Articles

Ultrasound appearance and targeted therapy of symptomatic neural lesions in the breast and chest wall after breast cancer surgery.

To evaluate the feasibility of ultrasound (US) in identification of nerve lesions after breast cancer surgery in patients with neuropathic pain and assess the effect of a targeted US-guided therapy. Patients with neuropathic pain after breast cancer surgery underwent US examination. Nerve lesions identified by US were treated by a US-guided application of a mixture of local anesthetics and corticoids. The patients reported pain relief on a 100-point scale (0% = no effect, 100% = complete relief) and its duration in the next 18 months. We performed 17 interventions in 11 women. A neuroma was observed in 2 patients, edema of the nerve in 5 patients, and scarring across the nerve in 4 patients. The affected nerves were the intercostobrachial nerve (5 patients), the long thoracic nerve (4), cutaneous branch of the pectoral nerve (1), and both the intercostobrachial and the long thoracic nerve (1). After 15 (88%) interventions, the patients reported relief (55±32%) with a median duration of 3 months (0.5-18 months). In patients after breast cancer surgery, ultrasound can reliably identify small painful neural lesions which can be efficiently treated by ultrasound-guided intervention.

An anthropomorphic thyroid phantom for ultrasound-guided radiofrequency ablation of nodules.

Needle-based procedures, such as fine needle aspiration and thermal ablation, are often applied for thyroid nodule diagnosis and therapeutic purposes, respectively. With blood vessels and nerves nearby, these procedures can pose risks in damaging surrounding critical structures. The development and validation of innovative strategies to manage these risks require a test object with well-characterized physical properties. For this work, we focus on the application of ultrasound-guided thermal radiofrequency ablation. We have developed a single-use anthropomorphic phantom mimicking the thyroid and surrounding anatomical and physiological structures that are relevant to ultrasound-guided thermal ablation. The phantom was composed of a mixture of polyacrylamide, water, and egg white extract and was cast using molds in multiple steps. The thermal, acoustical, and electrical characteristics were experimentally validated. The ablation zones were analyzed via non-destructive T2 -weighted magnetic resonance imaging scans utilizing the relaxometry changes of coagulated egg albumen, and the temperature distribution was monitored using an array of fiber Bragg grating sensors. The physical properties of the phantom were verified both on ultrasound as well as in terms of the phantom response to thermal ablation. The final temperature achieved (92°C), the median percentage of the nodule ablated (82.1%), the median volume ablated outside the nodule (0.8mL), and the median number of critical structures affected (0) were quantified. An anthropomorphic phantom that can provide a realistic model for development and training in ultrasound-guided needle-based thermal interventions for thyroid nodules has been presented.

Cost-effectiveness analysis of intravascular ultrasound-guided peripheral vascular interventions in patients with femoropopliteal peripheral artery disease.

Background: Intravascular ultrasound (IVUS)-guided percutaneous transluminal angioplasty (PTA) might offer clinical benefits compared to angiography-guided PTA in patients with peripheral artery disease (PAD). A cost-effectiveness model was developed to examine the benefits and costs of IVUS-guided PTA versus angiography-guided PTA in PAD patients with femoropopliteal (FP) occlusive disease. Methods: A two-step model (a one-year decision tree followed by a lifetime semi-Markov model) was developed from a German healthcare payer perspective to estimate the costs and outcomes over a one-year and lifetime horizon. Clinical events included target lesion revascularization (TLR), amputation, and death. Transition probabilities and utility values were derived from published literature. Healthcare costs were based on German Diagnosis Related Groups (DRG) codes. Costs and outcomes were discounted at a rate of 3% per year. The incremental cost-effectiveness ratio (ICER) was calculated, and sensitivity analyses were performed to assess the robustness of the results. Results: In the one-year horizon, IVUS-guided PTA resulted in incremental quality-adjusted life-years (QALY) and costs of 0.02 and €919 per patient respectively, with a corresponding ICER of €45,195/QALY gained versus angiography-guided PTA. In the lifetime horizon, IVUS-guided PTA outperforms angiography-guided PTA; it was associated with a cost saving of €46 per patient and incremental QALY of 0.22. Utility value for post-TLR, as well as probabilities of death and TLR had the greatest impact on the one-year ICER, while cost of TLR and probabilities of TLR and amputation influenced the lifetime ICER most. The probability of IVUS-guided PTA being cost-effective at a willingness-to-pay (WTP) threshold of €50,000/QALY was 50.4% in the one-year horizon and increased to 85.9% in the lifetime horizon. Conclusions: In this analysis IVUS-guided PTA among patients with symptomatic FP atherosclerosis was cost-saving in a lifetime horizon from the German healthcare payer perspective.

Cost-effectiveness of intravascular ultrasound-guided percutaneous intervention in patients with acute coronary syndromes: A UK perspective.

Use of intravascular ultrasound (IVUS) during percutaneous coronary intervention (PCI) is associated with improved clinical outcomes over angiography alone. Despite this, the adoption of IVUS in clinical practice remains low. To examine the cost-effectiveness of IVUS-guided PCI compared to angiography alone in patients with acute coronary syndromes (ACS). A one-year decision tree and lifetime Markov model were constructed to compare the cost-effectiveness of IVUS-guided PCI to angiography alone for two hypothetical adult populations consisting of 1,000 individuals: ST-elevation myocardial infarction (STEMI) and unstable angina/ non-ST-elevation myocardial infarction (UA/NSTEMI) patients undergoing drug-eluting stent (DES) implantation. The UK healthcare system perspective was applied using 2019/20 costs. All-cause death, myocardial infarction (MI), repeat PCI, lifetime costs, life expectancy and quality-adjusted life-years (QALYs) were assessed. Over a lifetime horizon, IVUS-guided PCI was cost-effective compared to angiography alone in both populations, yielding an incremental cost-effectiveness ratio of £3,649 and £5,706 per-patient in STEMI and UA/NSTEMI patients, respectively. In the one-year time horizon, the model suggested that IVUS was associated with reductions in mortality, MI and repeat PCI by 51%, 33% and 52% in STEMI and by 50%, 29% and 57% in UA/NSTEMI patients, respectively. Sensitivity analyses demonstrated the robustness of the model with IVUS being 100% cost-effective at a willingness-to-pay (WTP) threshold of £20,000 per QALY-gained. From a UK healthcare perspective, an IVUS-guided PCI strategy was highly cost-effective over angiography alone amongst ACS patients undergoing DES implantation due to the medium- and long-term reduction in repeat PCI, death, and MI.

Optical coherence tomography-guided versus intravascular ultrasound-guided percutaneous coronary intervention in patients with acute myocardial infarction

Introduction and objectivesOptical coherence tomography (OCT)-guided percutaneous coronary intervention (PCI) yields clinical outcomes comparable to intravascular ultrasound (IVUS)-guided PCI in patients with stable ischemic heart disease. However, there is a scarcity of data comparing the clinical outcomes of OCT-guided and IVUS-guided PCI in the setting of acute myocardial infarction (AMI). We sought to compare the clinical outcomes of OCT-guided vs IVUS-guided PCI for patients with AMI in the era of second-generation drug-eluting stent (DES). MethodsWe identified 5260 consecutive patients who underwent PCI with a second-generation DES for AMI under IVUS or OCT guidance from pooled data derived from a series of Korean AMI registries between 2011 and 2020. The primary endpoint was the 1-year rate of target lesion failure, defined as a composite of cardiac death, target vessel myocardial infarction, or ischemia-driven target lesion revascularization. ResultsA total of 535 (10.2%) and 4725 (89.8%) patients were treated under OCT and IVUS guidance, respectively. The 1-year target lesion failure rates were comparable between the OCT and IVUS groups before and after propensity score matching (hazard ratio, 0.92; 95%CI, 0.42-2.05, P=.84). The OCT utilization rate did not exceed 5% of total patients treated with second-generation DES implantation during the study period. The primary factors for the selection of OCT over IVUS were the absence of chronic kidney disease, non-left main vessel disease, single-vessel disease, stent diameter <3mm, and stent length ≤ 25mm. ConclusionsOCT-guided PCI in patients with AMI treated with a second-generation DES provided comparable clinical outcomes for 1-year target lesion failure compared with IVUS-guided PCI.

Rationale and design of a comparison of angiography-derived fractional flow reserve-guided and intravascular ultrasound-guided intervention strategy for clinical outcomes in patients with coronary artery disease: a randomised controlled trial (FLAVOUR II)

IntroductionPercutaneous coronary intervention (PCI) guided by coronary angiography-derived fractional flow reserve (FFR) or intravascular ultrasound (IVUS) has shown improved clinical outcomes compared with angiography-only-guided PCI. In patients with intermediate stenoses,...

Disconnected pancreatic duct syndrome in acute necrotising pancreatitis and outcomes of endoscopic ultrasound-guided interventions: a decade’s experience from a tertiary centre

Disconnected pancreatic duct syndrome in acute necrotising pancreatitis and outcomes of endoscopic ultrasound-guided interventions: a decade’s experience from a tertiary centre

Supraorbital and Auriculotemporal Nerve Entrapment: A Lesser-Known Cause of headache mimicking Migraine-like Symptoms

Extracranial headaches, although not rare, can be a significant contributor to chronic headaches, affecting approximately 4% of individuals. Among the potential causes of these headaches, entrapment neuropathy in the facial area is a prominent factor, with supraoptic nerve entrapment being a leading cause. The resulting pain typically manifests in the frontal forehead regions that are innervated by this nerve. Ultrasound-guided supraoptic nerve interventions serve a dual purpose, acting as both a diagnostic tool and a therapeutic measure, offering valuable benefits in managing this condition.

The 7th Saudi Spine Society Annual Conference Proceedings in November 2023 in Riyadh, Saudi Arabia

The Saudi Spine Society’s (SSS) 7th annual conference will be hosted in Riyadh November 17th - 19th, 2023 and is expected to have more than 550 attendees worldwide. The first day will include seven workshops covering spine diseases and management, including physical therapy, pain management, surgical treatment, evolving technology, and innovation in spine care and research. In the morning, three workshops will be conducted. These workshops will be about ultrasoundguided interventions as a treatment for common spine problems and intraoperative neurophysiological monitoring (IONM). The remaining workshops will be held in the afternoon. They will be about innovative techniques and technologies in spine surgery, neuro life-cervical spine trauma, clinical neurodynamics for the neuromusculoskeletal system and the essentials of writing medical research papers.&#x0D; This will be followed by two days of the main conference with several local, regional and international speakers. The keynote speaker will be Prof. Khahled Kebaish, who will speak about adult deformity surgery. Also, 45 lectures, including several keynotes from national and international leaders in spine, and 24 peer-reviewed abstracts will be presented.&#x0D; The conference halls will include new technologies and the latest surgical and nonsurgical equipment updates.

Ultrasound-Guided vs. Fluoroscopy-Guided Interventions for Back Pain Management: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

The objective of this study was to compare the outcomes of the ultrasound- and fluoroscopy-guided techniques in the management of back pain. Using PubMed, Scopus, and the Cochrane Library, we searched randomized controlled trials (RCTs) published before May 2023, which reported relevant data on the topic. The effectiveness of the ultrasound-guided (US-guided) and fluoroscopy-guided (FL-guided) approaches for back pain management was compared in terms of postoperative pain intensity, postoperative functional outcomes, and postoperative complications. Subgroup analyses were conducted for different postoperative periods. Eight studies were included in the analysis. There was no significant difference in post-procedural pain relief at one week, two weeks, one month, two months, and three months between the US-guided and FL-guided interventions for back pain management (SMD with 95% CI is -0.01 [-0.11, 0.10]), p = 0.91, I2 = 0%). In terms of the postoperative functional outcomes assessed by the "Oswestry Disability Index" (ODI) functionality score, the model tends to favor the FL-guided injections over the US-guided injections (SMD with 95% CI: 0.13 [-0.00, 0.25], p = 0.05, I2 = 0). Finally, the US-guided and FL-guided injections did not show significantly different results in terms of postoperative complications (RR with 95% CI is 0.99 [0.49, 1.99], p = 0.97, I2 = 0). The subgroup analysis also did not demonstrate differences between the US-guided and FL-guided techniques in the following outcomes: vasovagal reaction, transient headache, and facial flushing. There was no significant difference between the US-guided and FL-guided injections for treating back pain in terms of postoperative pain intensity and complications. Still, the model tends to favor the FL-guided injections over the US-guided injections in terms of functionality.

Computed tomographic predictors of a lipid-rich plaque identified by near-infrared spectroscopy

Abstract Background In a phase of primary prevention, individuals with high coronary calcium scores (CACS) assessed by computed tomographic coronary angiography (CTCA) are known to be associated with higher risk of atherosclerotic cardiovascular disease. However, clinical significance of CACS in patients requiring revascularization and its relevance to lipid core burden remains unknown. Purpose This study aimed to examine the relationship between lipid components assessed by near-infrared spectroscopy (NIRS) and coronary artery calcium score (CACS) assessed by preprocedural CTCA imaging. We also aimed to investigate CTCA-derived predictors of target vessels with high lipid core burden. Methods Consecutive patients who underwent preprocedural CTCA imaged within 3 months before elective NIRS-intravascular ultrasound-guided percutaneous coronary intervention (PCI) for de novo lesions in 1 coronary artery were included. Patients who had undergone stent deployment before inclusion were excluded. Target vessels requiring lesion modification such as balloon inflation or debulking before NIRS imaging were also excluded. Lipid rich plaque (LRP) was defined as a target lesion with maximum LCBI in 4 mm (maxLCBI4mm) &amp;gt;500. Clinical demographics, angiographic, and CTCA-derived morphological findings were compared between target vessels with and without LRP. Results A total of 95 target vessels in 95 patients were evaluated for the final dataset. NIRS identified 25 LRP and 70 non-LRP. Clinical demographics and angiographic findings showed no significant differences between vessels with versus without LRP. On CTCA, prevalence of high-risk plaque (HRP) that contains two or more of napkin-ring sign, positive remodeling, low attenuation plaque and spotty calcification at the target vessel was significantly higher in LRP group (56.0 % vs. 25.7 %, P=0.01). Target vessel CACS and total amount of 3-vessel CACS tended to be higher in patients with LRP than those without LRP (282 [124-479] vs. 114 [25-248], P=0.01; 882 [233-1501] vs. 308 [99-753], P=0.01, respectively). Multivariate logistic regression analyses to predict LRP at the target vessel revealed that the presence of HRP (odds ratio [OR] 3.52, 95% confidence interval [CI] 1.28-9.69, P=0.01) and higher 3-vessel CACS (per 100, OR 1.09, 95% CI 1.03-1.16, P &amp;lt;0.01) were independently predictive of LRP. Conclusions Preprocedural CTCA-derived high-risk plaque and total amount of 3-vessel CACS were independent predictors of LRP defined by NIRS.

Dual Antiplatelet Therapy Duration After Multivessel Optimal Intravascular Ultrasound-Guided Percutaneous Coronary Intervention.

There is a scarcity of data evaluating contemporary real-world dual antiplatelet therapy (DAPT) strategies after percutaneous coronary intervention (PCI). In the OPTIVUS-Complex PCI study multivessel cohort enrolling 982 patients undergoing multivessel PCI, including left anterior descending coronary artery using intravascular ultrasound (IVUS), we conducted 90-day landmark analyses to compare shorter and longer DAPT. DAPT discontinuation was defined as withdrawal of P2Y12inhibitors or aspirin for at least 2 months. The prevalence of acute coronary syndrome and high bleeding risk by the Bleeding Academic Research Consortium were 14.2% and 52.5%, respectively. The cumulative incidence of DAPT discontinuation was 22.6% at 90 days, and 68.8% at 1 year. In the 90-day landmark analyses, there were no differences in the incidences of a composite of death, myocardial infarction, stroke, or any coronary revascularization (5.9% vs. 9.2%, log-rank P=0.12; adjusted hazard ratio, 0.59; 95% confidence interval, 0.32-1.08; P=0.09) and BARC type 3 or 5 bleeding (1.4% vs. 1.9%, log-rank P=0.62) between the off- and on-DAPT groups at 90 days. The adoption of short DAPT duration was still low in this trial conducted after the release of the STOPDAPT-2 trial results. The 1-year incidence of cardiovascular events was not different between the shorter and longer DAPT groups, suggesting no apparent benefit of prolonged DAPT in reducing cardiovascular events even in patients who undergo multivessel PCI.

Effectiveness of different percutaneous electrolysis protocols in the endogenous modulation of pain: A Double-Blinded Randomized Clinical Trial

ObjectiveThis randomized clinical trial investigated if the application of percutaneous electrolysis (PE) enhances endogenous pain mechanisms (EPM) when compared with a simple needle application (acting as sham). MethodsForty-six asymptomatic subjects, aged 18–40 years, were randomized into three groups receiving a single ultrasound-guided PE intervention consisting of a needle insertion on the lateral epicondyle: sham (without electrical current), low-intensity (0.3 mA, 90s), or high-intensity (three pulses of 3 mA, 3s) PE. Widespread pressure pain thresholds (PPT), conditioned pain modulation (CPM), and temporal summation (TS) were bilaterally assessed in the lateral epicondyle, bicipital groove, transverse process of C5 and tibialis anterior muscle. Outcomes were obtained by an assessor blinded to the treatment allocation of the subjects. ResultsNo significant changes in CPM were observed in either group (omnibus ANOVA all, P > .05). A significant bilateral increase in PPT in the lateral epicondyle in the high intensity group as compared with the sham group was observed (P < .01). A significant decrease of TS in both low (P = .002) and high (P = .049) intensity groups on the right, but not on the left, tibialis anterior was also observed when compared with the sham group. ConclusionsOne session of PE is able to slightly stimulate modulatory pathways related to nociceptive gain, particularly pressure pain sensitivity and temporal summation but not conditioning pain modulation, when compared with a sham needle intervention, with changes even contralaterally. No significant differences were found between low- and high-intensity doses of percutaneous electrolysis.

TCT-696 Intravascular Ultrasound-Guided Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Left Main Coronary Artery Disease

TCT-696 Intravascular Ultrasound-Guided Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Left Main Coronary Artery Disease

Framework and guide for intralesional steroid injections in idiopathic granulomatous mastitis

PurposeLiterature on how to perform intralesional steroid injections, a valuable therapy for idiopathic granulomatous mastitis (IGM), is limited. This technical note offers a detailed technical guide on intralesional steroid injections for IGM and provides a framework for long-term follow-up. MethodsUltrasound characterization of IGM severity considering breadth, depth, and ancillary findings was used to guide steroid dosing and injection frequency. Clinical and sonographic breast diagrams were designed for accurate longitudinal tracking of IGM. A step-by-step guide for ultrasound-guided IGM aspirations and intralesional steroid injections was developed. ResultsA detailed approach for ultrasound-guided IGM interventions with clinical and sonographic breast diagrams for longitudinal follow-up is now in practice. ConclusionsThe treatment approach described provides a framework for multidisciplinary treatment of IGM and offers insights that may contribute to the ongoing development and improvement of management strategies for this challenging disease.

Ultrasound-guided interventions in primary carpal tunnel syndrome: perineural injection to thread carpal tunnel release.

Carpal tunnel syndrome (CTS), the most common entrapment neuropathy, is compression of the median nerve deep to transverse carpal ligament at wrist. Ultrasonography and electrophysiological study are complementary in the diagnosis and grading of CTS in appropriate clinical settings. The initial management of patients with CTS is conservative with medical therapy and splinting. However, surgical interventions are indicated in patients in whom medical management has failed. With evolution of the concept of safe zone on ultrasonography and identification of the sonoanatomical landmarks of carpal tunnel in greater detail, Ultrasonography-guided interventions are safer and preferred over surgical management in CTS. The primary ultrasonography-guided interventions include perineural injection, perineural hydrodissection and ultrasonography-guided release of transverse carpal ligament. This review article presents the principles of ultrasonography-guided perineural injection, perineural hydrodissection in CTS, the merits and demerits of injectant used in perineural injection/ hydrodissection, and percutaneous ultrasonography-guided thread release of transverse carpal ligament utilizing the concept of safe zone of the ultrasonography-guided interventions for CTS.

3-D Ultrafast Shear Wave Absolute Vibro-Elastography Using a Matrix Array Transducer.

Real-time ultrasound imaging plays an important role in ultrasound-guided interventions. The 3-D imaging provides more spatial information compared to conventional 2-D frames by considering the volumes of data. One of the main bottlenecks of 3-D imaging is the long data acquisition time, which reduces practicality and can introduce artifacts from unwanted patient or sonographer motion. This article introduces the first shear wave absolute vibro-elastography (S-WAVE) method with real-time volumetric acquisition using a matrix array transducer. In S-WAVE, an external vibration source generates mechanical vibrations inside the tissue. The tissue motion is then estimated and used in solving a wave equation inverse problem to provide the tissue elasticity. A matrix array transducer is used with a Verasonics ultrasound machine and a frame rate of 2000 volumes/s to acquire 100 radio frequency (RF) volumes in 0.05 s. Using plane wave (PW) and compounded diverging wave (CDW) imaging methods, we estimate axial, lateral, and elevational displacements over 3-D volumes. The curl of the displacements is used with local frequency estimation to estimate elasticity in the acquired volumes. Ultrafast acquisition extends substantially the possible S-WAVE excitation frequency range, now up to 800 Hz, enabling new tissue modeling and characterization. The method was validated on three homogeneous liver fibrosis phantoms and on four different inclusions within a heterogeneous phantom. The homogeneous phantom results show less than 8% (PW) and 5% (CDW) difference between the manufacturer values and the corresponding estimated values over a frequency range of 80-800 Hz. The estimated elasticity values for the heterogeneous phantom at 400-Hz excitation frequency show the average errors of 9% (PW) and 6% (CDW) compared to the provided average values by magnetic resonance elastography (MRE). Furthermore, both imaging methods were able to detect the inclusions within the elasticity volumes. An ex vivo study on a bovine liver sample shows less than 11% (PW) and 9% (CDW) difference between the estimated elasticity ranges by the proposed method and the elasticity ranges provided by MRE and acoustic radiation force impulse (ARFI).

Intravascular Ultrasound-Guided Versus Angiography-Guided Percutaneous Coronary Intervention With Drug-Eluting Stents: A Meta-analysis of Randomized Trials.

Intravascular Ultrasound-Guided Versus Angiography-Guided Percutaneous Coronary Intervention With Drug-Eluting Stents: A Meta-analysis of Randomized Trials.

Practical Electrochemical Method to Enhance Needle Visibility during Ultrasound Imaging.

Ultrasound-guided needle interventions play a pivotal role in the diagnosis and treatment processes in clinical practice. However, existing echogenic needles face challenges in achieving a balance between effectiveness, ease of manufacturing, and inexpensiveness. In this study, we developed an echogenic needle that encompassed the aforementioned advantages through the use of the electrolysis technology. The overall contour of the needle after electrolysis was observed using bright-field microscopy, while scanning electron microscopy (SEM) was employed to examine the micro-variations on the needle's surface. Subsequently, we validated the enhanced visualization effects in vitro (pork) and in vivo (anesthetized rabbit's thigh) puncture phantoms. To ensure the safety of the needles after the puncture procedure, we conducted Vickers hardness tests, SEM detection, bright-field microscopy, and DAPI staining. The results demonstrated that the surface roughness of the needle increased with the duration of electrolysis. Taking into account the comprehensive safety tests, the needle, subjected to 40 s of electrolysis, demonstrated a safe and effective enhancement of ultrasound visualization.

Optical Coherence Tomography-Guided or Intravascular Ultrasound-Guided Percutaneous Coronary Intervention: The OCTIVUS Randomized Clinical Trial.

Intravascular imaging-guided percutaneous coronary intervention (PCI) with intravascular ultrasound (IVUS) or optical coherence tomography (OCT) showed superior clinical outcomes compared with angiography-guided PCI. However, the comparative effectiveness of OCT-guided and IVUS-guided PCI regarding clinical outcomes is unknown. In this prospective, multicenter, open-label, pragmatic trial, we randomly assigned 2008 patients with significant coronary artery lesions undergoing PCI in a 1:1 ratio to undergo either an OCT-guided or IVUS-guided PCI. The primary end point was a composite of death from cardiac causes, target vessel-related myocardial infarction, or ischemia-driven target-vessel revascularization at 1 year, which was powered for noninferiority of the OCT group compared with the IVUS group. Safety outcomes were also assessed. At 1 year, primary end point events occurred in 25 of 1005 patients (Kaplan-Meier estimate, 2.5%) in the OCT group and in 31 of 1003 patients (Kaplan-Meier estimate, 3.1%) in the IVUS group (absolute difference, -0.6 percentage points; upper boundary of one-sided 97.5% CI, 0.97 percentage points; P<0.001 for noninferiority). The incidence of contrast-induced nephropathy was similar (14 patients [1.4%] in the OCT group versus 15 patients [1.5%] in the IVUS group; P=0.85). The incidence of major procedural complications was lower in the OCT group than in the IVUS group (22 [2.2%] versus 37 [3.7%]; P=0.047), although imaging procedure-related complications were not observed. In patients with significant coronary artery lesions, OCT-guided PCI was noninferior to IVUS-guided PCI with respect to the incidence of a composite of death from cardiac causes, target vessel-related myocardial infarction, or ischemia-driven target-vessel revascularization at 1 year. The selected study population and lower-than-expected event rates should be considered in interpreting the trial. URL: https://www. gov; Unique number: NCT03394079.