IVUS-Guided vs Angiography-Guided Stent Implantation in Complex Coronary Lesions (AVIO)

When stenting complex coronary lesions, does guiding the procedure with intravascular ultrasound produce better results than angiography alone? AVIO put the question to a randomized test.

In 284 patients with complex lesions, IVUS guidance achieved a significantly larger final lumen diameter — a better technical result. But that anatomical gain did not translate into fewer major adverse cardiac events at two years; the clinical outcomes were similar between the two approaches.

The pattern is a familiar one in interventional imaging trials: better-looking stents do not automatically mean better patient outcomes, at least not in a study of this size. AVIO showed IVUS optimizes the procedure without proving it changes the events that matter to patients.

We rate the evidence moderate. As a randomized trial it is sound, but its modest size and reliance on a procedural surrogate limit its reach; it contributes to, without settling, the long-running question of whether intravascular imaging guidance improves hard outcomes.