Abstract
This editorial refers to ‘Optical coherence tomography imaging during percutaneous coronary intervention impacts physician decision-making: ILUMIEN I study’, by W. Wijns et al ., on page doi:10.1093/eurheartj/ehv367. The field of intracoronary imaging emerged to overcome the drawbacks of coronary angiography. The visual evaluation of lesion severity of coronary stenosis by angiography remains insufficient for accurate diagnosis of the vessel indices and its estimate of functional significance.1 Intracoronary imaging was introduced to optimize the outcome of percutaneous coronary intervention (PCI), aiming to reduce short- and long-term cardiovascular events. Intracoronary imaging systems, such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT), offer an inside look into the artery, which enables precision in evaluation of the vessel dimension, plaque composition, and degree of narrowing, and allows optimization of management by selecting the appropriate method of intervention, such as pre-dilatation with balloon vs. direct stenting, use of atheroablative devices,2 stent sizing, and optimization of stent deployment and lesion coverage. IVUS-guided PCI has been in use for over two decades and has demonstrated a major contribution in regard to the importance of stent expansion and apposition that resulted in reduction of stent thrombosis. Overall, numerous studies showed that intracoronary imaging is safe and feasible for guidance of coronary interventions.3,4 However, the lack of adequately powered randomized clinical trials to support improvement in outcome, difficulties in image interpretation, and cost limited its utilization to guide routine PCI. Nevertheless, a few meta-analyses suggest that IVUS-guided stent placement could improve clinical outcome5 by reducing stent thrombosis, restenosis, and repeat revascularization.6 Other indications such as assessment of intermediate lesions by IVUS showed only modest correlation to fractional …
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