Aim: The aim of this study is to provide evidence how a standardized intravascular ultrasound (IVUS) use impacts clinical outcome after percutaneous coronary intervention (PCI) of a chronic total occlusion (CTO) compared to angiographic CTO PCI.

Methods and results: Data of 82 consecutive patients who had successfully undergone IVUS-guided revascularization of a CTO at the University Medical Center Mainz were compared to 107 patients angiographical guided CTO PCI. Propensity Score and inverse-probability-of-treatment weighting analysis were performed.

Before IPTW analysis, there was no difference in the outcome parameters in the follow-up after 210 ± 20 days. Rate of re-occlusion (2.77% vs. 1.88%), target vessel failure (8.33% vs 16.93%) and acute myocardial (0%) was low in both groups. TVF was numerically lower in the IVUS guided group (8.33% vs 16.93%, p 0.12). After IPTW analysis we still found a low event rate with numerically lower TVF (7.3% vs. 10.7%, p 0.61), re-occlusion (2.0% vs 3.2%, p 1.0).

Conclusions: Our results suggest that IVUS guided CTO PCI is feasible and safe. We found a low rate of complications and clinical events in both of our collectives. After IVUS assessment larger stent diameters were implanted which results in a lower restenosis rate in the IVUS guided collective compared to the angiographically guided collective.