Does Intravascular Imaging-guided Percutaneous Coronary Intervention Improve Clinical Outcomes?

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Intravascular imaging-guided percutaneous coronary intervention (PCI) may provide a more accurate assessment of the lumen and vessel dimensions and plaque characteristics than angiography-guided PCI and facilitate optimal coronary stent implantation. Several randomized controlled trials have demonstrated that intravascular ultrasound (IVUS)-guided PCI improved clinical outcomes compared to angiography-guided PCI, although randomized data comparing optical coherence tomography (OCT)-guided PCI to angiography-guided PCI are scarce. One randomized controlled trial suggested that OCT-guided PCI was noninferior to IVUS-guided PCI. The advantages of OCT over IVUS include a better resolution, leading to easier interpretation of the images, while the disadvantages of OCT compared to IVUS include the need for flushing to clear the blood in the lumen, difficulty evaluating severe stenosis or ostial lesions, and increased contrast volume. Despite the reported clinical benefits of intravascular imaging-guided PCI over angiography-guided PCI, the prevalence of IVUS use in US and European real clinical practice is still low and has only slightly increased over time. In addition, intravascular imaging was only rarely used in previous landmark trials comparing PCI vs. coronary artery bypass grafting (CABG), and there are no data comparing intravascular imaging-guided PCI to CABG. This review has gathered evidence concerning the efficacy of intravascular imaging-guided PCI and future perspectives on intravascular imaging-guided PCI.