Current Practice Patterns and Barriers to Intravascular Imaging–Guided Percutaneous Interventions: Insights from a Canadian Nationwide Survey

Background Despite robust evidence supporting intravascular imaging (IVI) to guide complex percutaneous coronary intervention (PCI), its adoption across Canada remains poorly defined. Methods A standardized cross-sectional electronic survey was distributed to catheterization laboratory directors across Canada. Results Sites were evenly distributed between academic 9 (43%) and non-academic 12 (57%) institutions, with a mean annual PCI volume of 1706±722 procedures. IVI integration into the catheterization laboratory was reported in 38/56 (68%) of laboratories, with a median of 6 PCI operators (IQR 5–9) per site. Operator comfort levels were generally good, with the majority of catheterization laboratory directors describing their operators as somewhat 6 (29%) or very experienced 9 (43%). Most directors (90%) perceived IVI to have a positive impact on outcomes. Overall, there was a trend toward an increase in IVI-guided PCI between 2022 and 2024 (15.6% vs. 19.1%, p=0.7). The most cited barriers to broader IVI use were increased procedure time (76%), cost of equipment or devices (67%), and reimbursement challenges (48%), with no differences between Ontario and non-Ontario sites (40% vs. 33%, p=1.0). Over half (52%) of centers planned IVI upgrades within the next two years. Conclusions Although IVI is widely available in Canadian catheterization laboratories, it remains underused due to barriers related to procedure time, workflow, and cost. A coordinated effort among key stakeholders is needed to reduce current barriers and promote broader guideline-concordant use IVI adoption.