High-Definition Intravascular Ultrasound Versus Optical Coherence Tomography: Lumen Size and Plaque Morphology

Background: Complex percutaneous coronary interventions rely on advanced intravascular imaging techniques, such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT). This study aims to compare the accuracy of the latest high-definition intravascular ultrasound (HD IVUS) and OCT technologies in measuring coronary lumen dimensions and assessing plaque morphology. Methods: We compared HD IVUS and OCT in 8 silicone models using microcomputed tomography as the ground truth. We also compared HD IVUS vs OCT in 12 coronary arteries from 9 patients. Results: In the silicone models, the latest HD IVUS (AVVIGO+, Boston Scientific) system overestimated lumen dimensions compared to microcomputed tomography by +0.06 ± 0.05 mm for mean lumen diameter (MLD). OCT (Ultreon 2.0, Abbott) underestimated lumen dimensions by –0.17 ± 0.06 mm for MLD, with the underestimation being greater for lumen diameters ≥5.0 mm. In clinical cases, the latest HD IVUS (AVVIGO+) system yielded larger lumen dimensions compared to OCT (Ultreon 2.0) by +0.12 ± 0.11 mm for MLD, and the earlier HD IVUS (POLARIS, Boston Scientific) system also showed larger lumen dimensions compared to OCT (AptiVue, Abbott) by +0.26 ± 0.29 mm for MLD. Using OCT as the reference, HD IVUS detected fine wall structures with precision, such as a thin fibrous cap, dissection, and stent struts. Conclusions: The latest HD IVUS (Avvigo+) tends to overestimate lumen size, whereas OCT (Ultreon 2.0) underestimates it. Experimental data suggest HD IVUS provides more accurate lumen assessment, particularly in larger coronary arteries, although both technologies exhibit comparable overall accuracy in the clinical setting.