A Systematic Review on the Use of Intravascular Ultrasound and Optical Coherence Tomography During Femoropopliteal Endovascular Intervention

Performing adjunctive intravascular imaging during femoropopliteal endovascular intervention could improve treatment planning and outcome. This systematic review assessed how imaging findings of intravascular ultrasound (IVUS) and optical coherence tomography (OCT) can contribute to improving treatment planning and outcomes of patients with femoropopliteal arterial disease. Scopus and PubMed databases were searched from January 2011 to July 2023 for all studies reporting on the use of IVUS or OCT imaging findings in the treatment of femoropopliteal disease. The effect of IVUS and OCT imaging findings on treatment plan and outcome, as well as the predictive ability of IVUS and OCT for treatment outcome, were analyzed. A total of 42 studies (one randomized-controlled trial, 17 prospective, 20 retrospective, and four descriptive studies), 34 involving IVUS, seven OCT, and one both, were included. IVUS-assessed diameters were significantly larger, and lesion length was longer compared to angiography, which affected treatment planning. OCT-measured diameters were significantly larger than angiography at follow-up and did not differ significantly from IVUS except for one location. Both IVUS and OCT identified more dissections, calcifications, residual stenoses, and inadequate stent expansion than angiography, impacting treatment planning. IVUS-assessed imaging findings were associated with reduced restenosis at 1 and 2-year follow-up compared to angiography alone, while for OCT, data was limited. IVUS and OCT can visualize complementary imaging features compared to angiography alone that change the treatment plan of patients with femoropopliteal disease, both pre- and post-treatment. IVUS has the potential to improve treatment outcomes, whereas there is still limited evidence for OCT.