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.

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Heart failure is a leading cause of morbidity and mortality all over the world. Heart failure may present at any age. Young patients present with heart failure of numerous etiologies. Ischemic heart disease, though rare, may also be seen. Early recognition and treatment are therefore crucial, as it might be reversible.
We describe the case of a young patient with familial hypercholesterolemia who presented with severe triple vessel disease and heart failure. The 19-year-old man with a strong family history of coronary artery disease with progressive exertional dyspnea and severe left ventricular dysfunction was diagnosed based on echocardiography. The lipid profile was unusual, with high total serum cholesterol and low-density lipoprotein cholesterol, with normal serum triglycerides. Genetic studies identified variants of low-density lipoprotein receptor and lipoprotein lipase genes. A coronary angiogram revealed severe triple vessel disease. The patient was started on dual antiplatelet and lipid-lowering drug therapy. He underwent a successful coronary artery bypass surgery after which a near-normal left ventricular function was attained. In conclusion, cases involving young patients with familial hypercholesterolemia with severe triple vessel disease presenting with heart failure symptoms are rare; however, early recognition and treatment are crucial for improving the prognosis of both young and adult patients.

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Anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is a rare congenital anomaly. We report a case of isolated ARCAPA in an adult patient who underwent reimplantation of the right coronary artery (RCA) into the aorta under cardiopulmonary bypass. The patient was diagnosed with ARCAPA during an examination for a lung mass. Cardiac scintigraphy using ^99mthallium and ¹²³I-β-methyl-P-iodophenyl-pentadecanoic acid showed myocardial ischemia in the area of the RCA. Cardiac catheterization showed a pulmonary/systemic flow ratio (Qp/Qs) of 1.38. To prevent coronary steal and establish a 2-vessel coronary artery system originating from the aorta, reimplantation of the RCA to the ascending aorta and closure of the main pulmonary artery were performed. The postoperative course was uncomplicated and the patient was discharged on the eleventh day after surgery. Postoperative coronary computed tomography showed good patency of the RCA.

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Acute myocardial infarction with cardiogenic shock (AMICS) has an extremely high mortality rate, despite the development of early reperfusion strategies and intensive cardiovascular care medicine. In most cases, residual damage to the left ventricular (LV) damage induces refractory heart failure, even after successful salvage from cardiac arrest and shock conditions in the acute phase. We herein report three cases of AMICS that were supported by a combination of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and the Impella percutaneous microaxial heart pump, collectively referred to as ECPELLA. The first case was supported by an Impella CP pump prior to percutaneous coronary intervention (PCI), followed by ECPELLA. After PCI, the Impella was upgraded to an Impella 5.0. However, the LV function did not recover [LV ejection fraction (LVEF) 24%], and the patient died due to intestinal ischemia. The second case was supported by VA-ECMO prior to PCI, followed by ECPELLA. The LV function did not recover (LVEF 25%), and the patient was transferred to the ventricular assist device/heart transplant center. The third case received ECPELLA prior to PCI. The patient was successfully weaned from VA-ECMO and Impella support. The LVEF recovered to 39%, and the patient was discharged from the hospital on day 47. Although all three patients were supported by ECPELLA in the acute phase, the LV load during PCI differed markedly among the three cases. ECPELLA, which provides sufficient systemic perfusion with total LV unloading, may contribute to myocardial protection in AMICS.

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