Comparison of Intravascular Ultrasound-guided With Optical Coherence Tomography-guided Percutaneous Coronary Intervention for Left Main Distal Bifurcation Lesions (ISOLEDS)

ISOLEDS

Patient / Population Intervention / Exposition Comparaison Critère de jugement

In 664 patients undergoing PCI of a distal left main bifurcation, OCT guidance was non-inferior to IVUS guidance for target lesion failure at 12 months.

N

664patients

Schéma

Prospective, multicentre (about 20 tertiary hospitals in China), open-label, 1:1 randomised non-inferiority trial; 12-month clinical follow-up with optional angiographic assessment of the target lesion at 12 months

Critère

Target lesion failure within 12 months after the procedure

Pertinence

2Important — l’un des piliers parmi d’autres.

RésultatTarget lesion failure at 12 months occurred in 14.4% with OCT and 19.6% with IVUS (adjusted HR 0.90, 95% CI 0.59–1.36; P = 0.0003 for non-inferiority) over a median 362 days of follow-up.

Zeng Y, et al. Presented at ESC Congress 2026, Hot Line 11, 31 August.

Discussion et critique

The distal left main bifurcation is where intravascular imaging earns its keep, and the question was never whether to image but which modality: OCT sees the vessel wall in detail but needs contrast and struggles with ostial views, IVUS penetrates deeper and needs neither. At 664 patients the two were interchangeable, with a numerically lower event rate under OCT that the confidence interval does not support as real. This settles operator choice rather than practice — use whichever the laboratory does well.