PCI Optimization Using Intravascular Imaging: Insights From Recent Trials

While previous studies have demonstrated the potential of intravascular imaging to improve percutaneous coronary intervention (PCI) outcomes, there were several limitations in terms of sample size, generalizability, and long-term follow-up.Therefore, routine use of intravascular ultrasound (IVUS) or optical coherence tomography (OCT) is not yet recommended in patients undergoing PCI for complex coronary artery lesions.Recently, several well-conducted trials on coronary intravascular imaging have been published and adds new evidence on the benefit of coronary intravascular imaging.This review aims to explore the role of intravascular imaging in optimizing PCI outcomes, drawing upon recent evidence from key trials and addressing the remaining issues.The results of the recent major trials can be summarized as follows: 1) Intravascular imaging improves clinical outcomes among patients undergoing PCI for complex coronary artery lesions; 2) OCT-guided PCI resulted in a larger minimum stent area than angiography-guided PCI, but failed to improve clinical outcomes among a broad spectrum of patients; 3) Intravascular imaging, IVUS or OCT, can be performed safely; and 4) OCT seems to be comparable to IVUS for guidance of PCI.While intravascular imaging holds tremendous potential for optimizing PCI outcomes, its underutilization in real-world practice highlights the need for concerted efforts to address barriers related to cost and operator experience.