Intravascular ultrasound and optical coherence tomography for the assessment of coronary artery disease and percutaneous coronary intervention optimization: Specific lesion subsets

Abstract

In contemporary practice, the legacy of coronary angiography as the “one technique” to answer all questions in interventional cardiology has been proven inaccurate. Intravascular imaging techniques have advanced from the framework of research to clinical decision-making in daily practice. Regardless of its routine use, angiography has several limitations that restrict the ability to accurately predict lesion architecture and hemodynamic significance. Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) images with far superior spatial resolution compared with angiography result in more precise characterization of lesion length, eccentricity, calcification, thrombus, necrotic cores, dissections, and stent apposition. Due to the technical complexity and potential prognostic implications, revascularization of specific subsets such as acute coronary syndrome, left main coronary artery, bifurcation, and chronic total occlusions poses additional challenges; therefore, it requires careful lesion preparation and cautiously optimized stenting for successful outcomes. Intravascular imaging has now become a mandatory procedural step in the therapeutic, interventional approach to treat these subsets and has been shown to improve stenting technique, procedure results, and consequently, patient outcomes. Stent malapposition, underexpansion, geographical miss, and significant stent edge dissection are all possible stent-related complications easily detectable by intravascular imaging. In this article, we present the salient features of evaluation and treatment of high-risk coronary interventions by IVUS and OCT.