ULTIMATE Trial: IVUS vs Angiography-Guided Implantation of DES

ULTIMATE Trial visual abstract summary
Visual abstract of the ULTIMATE trial

ULTIMATE Trial Key Points:

  1. At 12 months, patients undergoing IVUS guided PCI had lower rate of target vessel failure when compared to traditional andiography guided PCI.
  2. Enrolled patients had complex coronary disease including multi vessel disease as well as bifurcation blockages.
  3. The study re-emphasized the rationale for the more routine use of IVUS to guide PCI.

Current Guidelines on Use of IVUS for PCI

ESC guidelines:

  1. IVUS in selected patients for optimizing stent implantation. (Class IIa, LOE: B)
  2. IVUS to assess severity and guide management of unprotected left main stem disease. (Class IIa, LOE: C)

AHA/ACC Guidelines

  1. IVUS reasonable for assessment of angiographically indeterminate left main CAD. (Class IIa, LOE: B)


2018, IVUS vs angiography guided implantation of DES, JACC