Intracoronary Imaging: Current Practice and Future Perspectives

Abstract

Intracoronary imaging has brought new insight in the field of interventional cardiology. Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) are the most commonly used imaging modalities. Regarding their technical characteristics IVUS and OCT have similarities as well as differences, a fact that could have significant clinical implications. Both techniques play an important role in percutaneous coronary intervention (PCI) guidance and demonstrated superiority compared to intravascular coronary angiography (ICA) guidance alone. Furthermore, their use can notably assist coronary plaque evaluation; both provide additional information of plaque characteristics, which can lead to a better understanding of the cause of an acute coronary syndrome (ACS) and better clinical outcomes. However, there is not enough clinical evidence for the superiority of one method compared to the other, something that is, also, reflected in the guidelines. In this review, we aim to compare role of IVUS and OCT in the different aspects of coronary artery disease (CAD), according to the latest scientific data. In addition, we present the future perspectives regarding the IVUS and OCT, with co-registration of the two methods or hybrid OCT-IVUS catheters.

Efficacy and Safety of Thirty-Day Dual-Antiplatelet Therapy Following Complex Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis

“…OCT affords high-fidelity visualization of the vascular wall, lumen, constituent elements of plaques, potential dissections, and stent structures, enabling meticulous measurements and optimization in the intricate realm of percutaneous coronary intervention. Consequently, the implementation of OCT-guided complex PCI may yield discernible clinical advantages [34,37]. Indeed, OCT usage has gained important ground in clinical practice, as its application has sextupled between 2010 and 2019 [38].…”

Thirty-Days versus Longer Duration of Dual Antiplatelet Treatment after Percutaneous Coronary Interventions with Newer Drug-Eluting Stents: A Systematic Review and Meta-Analysis

“…Subanalyses of the existing meta-analyses did not discover any difference between these two time frames’ regimens [ 32 ]. However, stents’ evolution, intravascular imaging progress and interventional techniques’ development will reduce further ischemic complications (MI, stent thrombosis and revascularization) and trials studying 30- with 90-days DAPT will try to resolve this dilemma [ 45 , 46 ].…”

OCT Guidance in Bifurcation Percutaneous Coronary Intervention

“…Intravascular optical coherence tomography (OCT) is a valuable adjunctive tool for guiding coronary bifurcation PCI. OCT provides high resolution (axial 10–20 m, lateral 20–40 m) 10 times higher compared with intravascular ultrasound (IVUS) [ 7 ]. The OCT catheter is advanced distal to the lesion or stent to be examined, and the pullback is performed with a speed of 10–40 mm/s until either the guiding catheter is reached or the maximal pullback length is completed.…”