IVUS and OCT: Current State-of-the-Art in Intravascular Coronary Imaging

Abstract

To summarize the current state-of-the-art of intracoronary imaging with a focus on clinical outcomes, novel approaches, and anticipated future developments. Multiple randomized trials have demonstrated that intravascular ultrasound (IVUS) guidance of percutaneous coronary intervention (PCI) significantly reduces major cardiac adverse events (MACE), and in particular, rates of target lesion failure or clinical restenosis. High-definition IVUS enhances the ability to visualize stent struts and plaque components. Optical coherence tomography (OCT) offers a greater resolution and can image many plaque morphology and stent characteristics that are not visualized with IVUS. Image guidance should be considered strongly in complex PCI lesions and potentially in all-comers. Multimodality imaging using near-infrared spectroscopy or fluorescence, combined with IVUS or OCT, is an exciting new approache to image plaque lipid, intraplaque hemorrhage, inflammation, and fibrin deposition. Intravascular imaging guidance of PCI utilizing IVUS or OCT definitively improves outcomes in many patient subsets but remains heavily underutilized. Emerging intravascular imaging modalities, such as near-infrared spectroscopy and near-infrared fluorescence imaging, will allow for improved plaque and stent characterization. As cath lab integration, automated image segmentation, and x-ray co-registration evolve further, we envision that intravascular imaging will become a routine for the vast majority of PCI patients, with resultant benefits in clinical outcomes.