Intravascular ultrasound and optical coherence tomography for the assessment of coronary artery disease and percutaneous coronary intervention optimization: The basics

Abstract

Although coronary angiography is the standard method employed to assess the severity of coronary artery disease and to guide treatment strategies, it provides only two-dimensional image of the intravascular lesions. In contrast with the luminogram obtained by angiography, intravascular imaging produces cross-sectional images of the coronary arteries of far greater spatial resolution, capable of accurately determining vessel size as well as plaque morphology, and eliminates some of the disadvantages inherent to angiography, such as contrast streaming, foreshortening, vessel overlap, and angle dependency. Growing body of literature recommends intravascular imaging, especially intravascular ultrasound and optical coherence tomography, which can be competently used to answer questions that arise during daily practice in interventional cardiology such as: Is this stenosis clinically relevant? Which is the culprit lesion? Is this plaque at high risk for rupture? How can I optimize stent results? Why did thrombosis or restenosis occur in this stent? Patients with more complex coronary disease likely benefit more from a revascularization approach that includes intravascular imaging. The aim of this review was to discuss the basic principles of intravascular imaging, characterization of atherosclerosis, optimization of angioplasty results and to identify technical challenges because of artefacts.