Role Of Intravascular Imaging Research Articles

Role of Intravascular Imaging in Complex Percutaneous Coronary Intervention: A Meta-Analysis of Randomized Controlled Trials

Intravascular imaging (IVI) during percutaneous coronary intervention (PCI) has been shown to improve clinical outcomes. However, data is limited in complex PCI and the adoption remains low. We aimed to conduct a meta-analysis of all available randomized controlled trials comparing IVI with conventional angiography in patients who underwent complex PCI. The primary outcomes of interest were major adverse cardiovascular events, all-cause death, cardiovascular death, myocardial infarction, stent thrombosis, target lesion revascularization and target vessel revascularization. Random-effects model was used to calculate pooled risk ratios (RRs) and 95% confidence intervals (CIs). A total of 10 randomized controlled trials comprising 6,368 patients with 3,452 in the IVI group and 2,916 in the angiography group were included. The mean duration of follow up was 2years, mean age was 65years and 73% of patients were men. As compared with PCI with routine angiography, the IVI-guided PCI group had significantly lower risks of major adverse cardiovascular events (RR 0.65, 95% CI 0.56 to 0.75, p <0.00001), stent thrombosis (RR 0.57, 95% CI 0.36 to 0.92, p=0.02), cardiovascular deaths (RR 0.46, 95% CI 0.31 to 0.68, p=0.0001), target lesion revascularization (RR 0.61, 95% CI 0.48 to 0.78, p <0.0001) and target vessel revascularization (RR 0.62, 95% CI 0.48 to 0.80, p=0.0003). All-cause deaths and MI were similar in the 2 groups. In conclusion, among patients who underwent complex PCI, IVI reduces adverse events, importantly stent thrombosis and repeat revascularizations, compared with angiography alone guided PCI.

The role of intravascular imaging in chronic total occlusion percutaneous coronary intervention.

Chronic total occlusions (CTOs) represent the most complex subset of coronary artery disease and therefore careful planning of CTO percutaneous coronary recanalization (PCI) strategy is of paramount importance aiming to achieve procedural success, and improve patient's safety and post CTO PCI outcomes. Intravascular imaging has an essential role in facilitating CTO PCΙ. First, intravascular ultrasound (IVUS), due to its higher penetration depth compared to optical coherence tomography (OCT), and the additional capacity of real-time imaging without need for contrast injection is considered the preferred imaging modality for CTO PCI. Secondly, IVUS can be used to resolve proximal cap ambiguity, facilitate wire re-entry when dissection and re-entry strategies are applied and most importantly to guide stent deployment and optimization post implantation. The role of OCT during CTO PCI is currently limited to stent sizing and optimization, however, due to its high spatial resolution, OCT is ideal for detecting stent edge dissections and strut malapposition. In this review, we describe the use of intravascular imaging for lesion crossing, plaque characterization and wire tracking, extra- or intra-plaque, and stent sizing and optimization during CTO PCI and summarize the findings of the major studies in this field.

Calcific lesions are the last frontier of endovascular therapies.

Key Points This study brings new important insights on the role of drug‐coated balloons for calcific lesions management in peripheral interventions, being this therapeutic option less performant in longer calcifications, as assessed by PACSS methodology. The role of intravascular imaging and atherectomy devices, and if these rules can be applied also to coronary arteries is still not understood. Calcified arteries are the last frontier of endovascular interventions, and ongoing adequately powered studies will hopefully shed light on the best treatment for this complex scenario.

Role of Intravascular Imaging in the Diagnosis and Treatment of Spontaneous Coronary Artery Dissection

The objective of this article is to review the role of intracoronary imaging in the management of patients with spontaneous coronary artery dissection (SCAD). In this review article, we discuss the types of intracoronary imaging including intravascular ultrasound (IVUS) and optical coherence tomography (OCT) and their relative strengths and weaknesses. Additionally, we discuss in detail the findings on IVUS and OCT and how these modalities can be used for optimization of percutaneous coronary intervention (PCI) in SCAD cases. While coronary angiography is the first-line investigation for diagnosis of SCAD, it remains inconclusive in a considerable proportion of cases owing to the widely varying appearance of SCAD on angiography. Even though the vast majority of SCAD cases are treated conservatively, PCI may be required in cases with hemodynamic instability. Intracoronary imaging becomes critical in the two aforementioned situations, either for making a conclusive diagnosis of SCAD or for optimization of PCI. Intracoronary imaging has a vital role to play in the diagnosis and management of SCAD patients. Interventional cardiologists should be well versed with the findings on IVUS and OCT to diagnose SCAD and utilize it for optimization of PCI. However, it is important to exercise caution in performing intracoronary imaging and follow safe practices.

Left Main Coronary Artery Interventions.

The management of left main coronary artery (LMCA) disease has evolved over the past two decades. Historically, coronary artery bypass grafting (CABG) surgery has been the gold standard for the treatment of LMCA disease. However, with the advancements in percutaneous coronary interventions (PCIs) and stent technology, PCI in select patients has achieved comparable outcomes to CABG. As such, this has led to changes in the American College of Cardiology and European Society of Cardiology guidelines, which recommend that PCI might be an alternative to CABG in select patients. In this review article, we describe the historical perspective and early experience with coronary interventions of LMCA disease, landmark clinical trials and their effect on guidelines, and the role of intravascular imaging in the management of LMCA lesions.

Using IVUS to improve treatment of complex lesions in the femoropopliteal arteries

Despite rapid advances in in peripheral endovascular therapy over the last 15 years, the rate of restenosis and revascularization in the femoropopliteal arteries remains high. This is particularly the case for more complex lesions, such as longer lesions, those with severe calcification and chronic total occlusions (CTO). The recognised limitations of angiography, particularly the planar and luminal nature of the imaging, result in incomplete assessment of lesion characteristics which may well contribute to problems with achieving satisfactory outcomes. Intravascular ultrasound (IVUS) is a fundamentally different mode of imaging to angiography and is able to produce high quality imaging of the entire artery rather than just the lumen. IVUS provides a range of imaging parameters, many of which are unique to this form of imaging and are unobtainable with angiography. IVUS can therefore assist with a more complete characterisation of the artery and lesion beyond the luminal silhouette and diameters provided by angiography. In this presentation, the role of intravascular imaging (IVUS) in treating complex femoropopliteal lesions will be reviewed, drawing on more than five years’ experience with this technology. The value of IVUS both before and after treatment will be discussed. This will include how pre-treatment IVUS imaging can assist selection of the most appropriate treatment methods by providing accurate assessment of vessel dimensions, length of the diseased segment, severity of calcification, presence of negative remodelling and the degree of plaque eccentricity. This information can inform the choice of treatment technology as well as optimising device size and the length of treatment. IVUS can also provide unique information after initial treatment. This includes accurate measurement of minimum lumen size post angioplasty and stenting, the presence of dissection and the effects of atherectomy, including assessment of the effectiveness of plaque removal and identification of vessel wall damage. IVUS imaging is simple, quick and safe to use during endovascular interventions and can provide unique information that can supplement standard angiographic imaging and help optimise treatments.