Vol. 8, Issue 1, Part A (2026)

Background: Guidance for percutaneous coronary intervention using the instantaneous wave-free ratio (iFR) or intravascular ultrasound (IVUS)-guided PCI could provide more favorable outcomes than angio-guided PCI by confirming the lesion’s hemodynamic significance and characteristics. The aim of this work was to compare the efficacy of iFR- guided PCI strategy with IVUS-guided PCI strategy in clinical outcomes of patients with intermediate coronary stenosis.
Methods: This prospective observational single-center investigation included 50 patients, with intermediate degree of stenosis eligible for stent implantation who need iFR or IVUS for further evaluation, target vessel size ≥ 2.5 mm and target lesions located at the proximal to mid part of coronary artery. All patients were subjected to iFR-guided (group I) and IVUS-guided PCI (group II). Patients were followed up for in-hospital, 30-day, and 6-month MACE (death, non-fatal MI, target lesion revascularization).
Results: Left ventricular ejection fraction, angiographic findings and laboratory investigations were insignificantly different between both groups. Procedural findings and interventional details were insignificantly different among both groups. There were no significant differences between the two groups regarding contrast used in the procedure and primary and secondary outcomes at one and six months. Radiation dose was significant difference between two groups with higher dose of radiation in the IVUS group (P=0.019).
Conclusion: Accurate physiological iFR and morphological IVUS assessments of intermediate coronary lesions are crucial for guiding decision-making and ensuring optimal outcomes. IVUS helps evaluate lesion characteristics, stenosis degree, plaque burden, and stent landing, while iFR identifies physiologically significant lesions and confirms results post-stent deployment.