Impact of Plaque Eccentricity on Post-Stenting Vessel Geometry Assessed by Intravascular Ultrasound in Patients Undergoing Percutaneous Coronary Intervention

Coronary plaque morphology influences stent deployment mechanics. Eccentric plaque, often co localized with calcification, can resist uniform expansion, leading to asymmetric stent geometry and malapposition, both linked to adverse outcomes. IVUS provides high-resolution cross-sectional visualization, enabling quantification of plaque burden, distribution, and luminal/stent geometry. While IVUS-guided PCI improves achievement of larger MSA and reduces adverse events compared with angiography-guided strategies, the specific role of pre-stent plaque eccentricity as a predictor of post stent eccentricity is less well established in prospective real-world Indian cohorts. Some prior studies have reported correlations between calcific arcs, eccentric burden, and under-expansion; however, definitions of eccentricity and thresholds vary, and many analyses are post-hoc or limited by small samples and heterogeneous methodologies. A focused, prospective core-lab study using standardized IVUS definitions and motorized pullbacks can address these gaps. By adjusting for confounders (vessel size, lesion length, calcification severity, stent sizing, and post-dilatation), this study aims to isolate the independent contribution of plaque eccentricity to stent symmetry. The findings could inform lesion preparation (atherectomy or specialty balloons in highly eccentric, calcific plaques), refine stent sizing, and establish pragmatic imaging-based algorithms to target symmetric expansion and adequate MSA.