{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:57:36Z","timestamp":1785891456577,"version":"3.56.0"},"reference-count":30,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2023,7,27]],"date-time":"2023-07-27T00:00:00Z","timestamp":1690416000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Italian Ministry of University and Research","award":["CN00000041"],"award-info":[{"award-number":["CN00000041"]}]},{"name":"Italian Ministry of University and Research","award":["PSC SALUTE 2014-2020 -POS4 \u201cCal-Hub-Ria\u201d-T4-AN-09"],"award-info":[{"award-number":["PSC SALUTE 2014-2020 -POS4 \u201cCal-Hub-Ria\u201d-T4-AN-09"]}]},{"name":"Italian Ministry of University and Research","award":["PNRR-MAD-2022-12376814"],"award-info":[{"award-number":["PNRR-MAD-2022-12376814"]}]},{"name":"Italian Ministry of Health","award":["CN00000041"],"award-info":[{"award-number":["CN00000041"]}]},{"name":"Italian Ministry of Health","award":["PSC SALUTE 2014-2020 -POS4 \u201cCal-Hub-Ria\u201d-T4-AN-09"],"award-info":[{"award-number":["PSC SALUTE 2014-2020 -POS4 \u201cCal-Hub-Ria\u201d-T4-AN-09"]}]},{"name":"Italian Ministry of Health","award":["PNRR-MAD-2022-12376814"],"award-info":[{"award-number":["PNRR-MAD-2022-12376814"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Chronic total occlusions (CTO) in coronary angiographies present a significant challenge nowadays. Intravascular ultrasound (IVUS) is a valuable tool during CTO-PCI, aiding in planning and achieving procedural success. However, the impact of IVUS on clinical and procedural outcomes in CTO-PCI remains uncertain. This meta-analysis aimed to compare IVUS-guided and angiography-guided approaches in CTO-PCI. The study included five studies and 2320 patients with stable coronary artery disease (CAD) and CTO. The primary outcome of major adverse cardiac events (MACE) did not significantly differ between the groups (p = 0.40). Stent thrombosis was the only secondary clinical outcome that showed a significant difference, favoring the IVUS-guided approach (p = 0.01). Procedural outcomes revealed that IVUS-guided procedures had longer stents, larger diameters, and longer procedure and fluoroscopy times (p = 0.007, p &lt; 0.001, p = 0.03, p = 0.002, respectively). Stent number and contrast volume did not significantly differ between the approaches (p = 0.88 and p = 0.33, respectively). In summary, routine IVUS use did not significantly improve clinical outcomes, except for reducing stent thrombosis. Decisions in CTO-PCI should be individualized based on patient characteristics and supported by a multi-parametric approach.<\/jats:p>","DOI":"10.3390\/jcm12154947","type":"journal-article","created":{"date-parts":[[2023,7,28]],"date-time":"2023-07-28T02:08:00Z","timestamp":1690510080000},"page":"4947","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Clinical and Procedural Outcomes of IVUS-Guided vs. Angiography-Guided CTO-PCI: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"12","author":[{"given":"Giuseppe","family":"Panuccio","sequence":"first","affiliation":[{"name":"Department of Medical and Surgical Sciences, Magna Graecia University, 88100 Catanzaro, Italy"},{"name":"Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charit\u00e9 Berlin, 12200 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2708-4596","authenticated-orcid":false,"given":"Youssef S.","family":"Abdelwahed","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charit\u00e9 Berlin, 12200 Berlin, Germany"},{"name":"DZHK (German Centre for Cardiovascular Research), 10785 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Carabetta","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, Magna Graecia University, 88100 Catanzaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadia","family":"Salerno","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David Manuel","family":"Leistner","sequence":"additional","affiliation":[{"name":"Department of Medicine, Cardiology, Goethe University Hospital, 60596 Frankfurt, Germany"},{"name":"German Center for Cardiovascular Research, Partner Site RheinMain, 60590 Frankfurt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulf","family":"Landmesser","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charit\u00e9 Berlin, 12200 Berlin, Germany"},{"name":"DZHK (German Centre for Cardiovascular Research), 10785 Berlin, Germany"},{"name":"Berlin Institute of Health (BIH), 10178 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5388-942X","authenticated-orcid":false,"given":"Salvatore","family":"De Rosa","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, Magna Graecia University, 88100 Catanzaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4915-5084","authenticated-orcid":false,"given":"Daniele","family":"Torella","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6011-0135","authenticated-orcid":false,"given":"Gerald S.","family":"Werner","sequence":"additional","affiliation":[{"name":"Medizinische Klinik I Klinikum Darmstadt, 64283 Darmstadt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,7,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1038\/s41569-021-00607-3","article-title":"Epidemiology of cardiovascular disease in Europe","volume":"19","author":"Townsend","year":"2022","journal-title":"Nat. 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