Intravascular Imaging vs Angiography Guidance for PCI of Severely Calcified Lesions: The ECLIPSE Trial
Recommended Citation
Stone GW, Genereux P, Maehara A, Lewis BE, Shlofmitz RA, Dohad S, Choudary J, Dahle T, Pineda AM, Shunk K, Mahmud E, Weisz G, Collins MB, Alaswad K, Kumar G, Solankhi N, Dulas D, Altman JD, Kraemer C, Stiefel KM, Jones DE, Buccola JR, and Kirtane AJ. Intravascular Imaging vs Angiography Guidance for PCI of Severely Calcified Lesions: The ECLIPSE Trial. JACC Cardiovasc Interv 2025;18(19):2338-2351.
Document Type
Article
Publication Date
10-13-2025
Publication Title
JACC Cardiovasc Interv
Keywords
Humans, Male, Female, Tomography, Optical Coherence, Ultrasonography, Interventional, Vascular Calcification, Coronary Artery Disease, Aged, Middle Aged, Coronary Angiography, Time Factors, Predictive Value of Tests, Severity of Illness Index, Atherectomy, Coronary, Risk Factors, Drug-Eluting Stents, Angioplasty, Balloon, Coronary, Progression-Free Survival, Treatment Outcome, Percutaneous Coronary Intervention
Abstract
BACKGROUND: Few studies have examined whether intravascular imaging (IVI) guidance during percutaneous coronary intervention (PCI) of calcified lesions improves clinical outcomes.
OBJECTIVES: The aim of this study was to determine from a large-scale randomized trial of PCI in severely calcified lesions whether IVI guidance improves event-free survival.
METHODS: In the ECLIPSE (Evaluation of Treatment Strategies for Severe Calcific Coronary Arteries: Orbital Atherectomy vs. Conventional Angioplasty Technique Prior to Implantation of Drug-Eluting Stents) trial, 2,005 patients with severely calcified lesions were randomized to orbital atherectomy (OA) vs balloon angioplasty (BA) prior to drug-eluting stent placement. IVI with optical coherence tomography or intravascular ultrasound (IVUS) was allowed at operator discretion. The primary clinical outcome was the 1-year rate of target vessel failure (TVF).
RESULTS: IVI guidance was used in 1,246 of 2,005 patients (62.1%), including optical coherence tomography in 819 and/or IVUS in 513, while 759 of 2,005 patients (37.9%) underwent PCI with angiographic guidance alone. Median follow-up duration was 365 days (Q1-Q3: 365-365 days). The 1-year Kaplan-Meier estimated rate of TVF was lower among patients with IVI guidance compared with angiographic guidance alone (9.3% vs 13.2%; adjusted HR: 0.74; 95% CI: 0.56-0.97; P = 0.03). The effect of IVI guidance was consistent in patients randomized to OA vs BA (P(interaction) = 0.48). The 1-year rate of TVF was 7.7% after optical coherence tomographic guidance compared with 12.2% after IVUS guidance (adjusted HR: 0.78; 95% CI: 0.52-1.18; P = 0.24).
CONCLUSIONS: IVI guidance during PCI of severely calcified lesions was associated with improved 1-year clinical outcomes compared with angiographic guidance alone, whether OA or BA was used for vessel preparation prior to drug-eluting stent placement. The adjusted difference in 1-year TVF rates were not significantly different with optical coherence tomographic guidance and IVUS guidance.
Medical Subject Headings
Humans; Male; Female; Tomography, Optical Coherence; Ultrasonography, Interventional; Vascular Calcification; Coronary Artery Disease; Aged; Middle Aged; Coronary Angiography; Time Factors; Predictive Value of Tests; Severity of Illness Index; Atherectomy, Coronary; Risk Factors; Drug-Eluting Stents; Angioplasty, Balloon, Coronary; Progression-Free Survival; Treatment Outcome; Percutaneous Coronary Intervention
PubMed ID
41093451
Volume
18
Issue
19
First Page
2338
Last Page
2351
