Molecular multimodality imaging: has a long-standing dream come true?

This editorial refers to ‘Intravascular fibrin molecular imaging improves the detection of unhealed stents assessed by optical coherence tomography in vivo ’, by T. Hara et al . on doi:10.1093/eurheartj/ehv677 Intravascular imaging has incrementally gained in clinical relevance in recent years. First triggered by the introduction of intravascular ultrasound >25 years ago,1 interest has recently been augmented by the widespread implementation of optical coherence tomography (OCT) in cardiac catheterization laboratories. OCT, because of its outstanding spatial resolution in the range of 10–20 μm relative to comparative invasive and non-invasive imaging modalities, has been charged with great expectations regarding its potential to advance our capabilities in detecting and characterizing vascular pathologies. In particular for patients undergoing stent implantation, OCT has been put forward as a promising tool to assess the status of vascular healing, which has been identified as an important landmark in pathology studies determining the risk of acute and late thrombotic events in stented coronary arteries.2 Furthermore, the ongoing dispute about the optimal duration of dual antiplatelet therapy following drug-eluting stent (DES) implantation,3,4 along with demands to personalize clinical decision-making in this regard, further fuelled the need for clinical surrogate parameters enabling clinicians to appreciate the status of vascular healing. However, despite the unequivocal agreement among interventional cardiologists that OCT is the most likely technology to fulfil these expectations, evidence derived from prospective clinical trials is still lacking to date. Furthermore, the unconditional acceptance of OCT to detect vascular pathologies reliably has recently been challenged by reports describing its limitations in differentiating critical components of the status of vascular healing following stent implantation, such as endothelialization and fibrin deposition.5 In …