Intravascular Ultrasound (IVUS) versus Optical Coherence Tomography (OCT) in the Era of High-Potency Statins: A Comparative Analysis of Plaque Morphological Assessment.

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Original Research | 2025 | Volume 1 | Issue 1 | Page 70-79

Dr. Ibrahim Kureshy, Lecturer, Cardiology, DMCH-UAE

Dr. Rabia Fatima, Lecturer, Cardiology, DMCH-UAE

Abstract

The clinical management of coronary artery disease has evolved from a focus on luminal diameter to a deep molecular understanding of Plaque Vulnerability. In the 2024–2026 era, the widespread use of high-potency statins, PCSK9 inhibitors, and Inclisiran has fundamentally altered the "Biological Landscape" of the arterial wall. This review evaluates the comparative diagnostic efficacy of Intravascular Ultrasound (IVUS) and Optical Coherence Tomography (OCT) in assessing coronary plaque morphology within this "Stabilized" pharmacological environment.

We examine the methodological "Strength-to-Resolution" trade-off: IVUS, with its superior acoustic penetration, remains the gold standard for assessing Vessel Remodeling and deep Calcium Volume, essential for complex CHIP interventions. Conversely, OCT, with its near-histological resolution ($10\text{–}15\mu\text{m}$), is unmatched in identifying the "Thin-Cap Fibroatheroma" (TCFA) and measuring the Fibrous Cap Thickness (FCT)—the primary determinant of plaque rupture. A primary focus is placed on the "Plaque Cooling" effect of intensive lipid-lowering therapy, where OCT is utilized to track the increase in cap thickness and the reduction in lipid-core burden over time. By synthesizing data from the ILUMIEN IV and RENOVATE-COMPLEX-PCI trials, this paper discusses the emerging concept of "Hybrid Imaging," where AI-driven co-registration combines the deep-vessel insights of IVUS with the surface-level precision of OCT. This review concludes that in the modern era, the choice between IVUS and OCT is no longer binary but is dictated by the specific clinical goal: structural optimization versus biological risk stratification.