April 24, 2026Journal of the American College of Cardiology
Intravascular Imaging During Percutaneous Coronary Intervention
Key result
Intravascular imaging adds valuable utility to conventional angiography for optimizing PCI in complex lesions.
Why the study?
Intravascular imaging has emerged to complement conventional angiography during PCI, but an overview of available technologies, supporting data across lesion subsets, and proposed best practices was needed.
Does intravascular imaging reduce major adverse cardiac events in patients undergoing percutaneous coronary intervention?
Key Points
- This research aims to assess the impact of intravascular imaging on percutaneous coronary intervention outcomes and identify optimal practices for its use.
- Overview of intravascular imaging technologies available for PCI
- Review of data supporting utilization in various lesion subsets
- Proposed best practices for integrating IVI into standard procedures
- Intravascular imaging is shown to enhance plaque assessment and lesion preparation prior to PCI.
- Emerging evidence suggests reduced major adverse cardiac events with the use of IVI in complex lesions.
- Broader adoption of IVI technologies is advocated based on promising outcomes.
Structured PICO
Does intravascular imaging reduce major adverse cardiac events in patients undergoing percutaneous coronary intervention?
P
Population
Patients with coronary artery disease undergoing percutaneous coronary intervention
I
Intervention
Intravascular imaging (IVI) technologies
C
Comparator
Conventional angiography
Intravascular imaging is an important adjunct to conventional angiography for optimizing PCI performance and characterizing plaque morphology.
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
ESElliot SteinInterventional cardiologist, University of Washington Medical Center
“If we agree that intravascular imaging use is beneficial for patients, and we know that we can measure it in a reliable way, then it's incorporation into the guidelines should be considered.”
DFDmitriy FeldmanInterventional cardiologist, Weill Cornell Medicine
“I don't think making it a formal performance measure at this point would be helpful because I think it may incentivize wrong behavior, meaning that imaging in 100% of cases without an ability to thoughtfully interpret the imaging that you do and use the data to optimize the PCI result... is not going to lead to a meaningful improvement in outcomes. Imaging itself doesn't do that. It's using the imaging, using the data, and then optimizing your PCI based on that data [that is] going to lead to improved technical results and then a long-term clinical improvement.”
“I was in New York during the pandemic. It was impossible to go to the doctor or the hospital. Nobody wanted to come in for a checkup. In fact, the number of reported heart attacks around the country dropped around 50% because people were so worried about getting the virus that they suffered their heart attack at home.”
Implication
IVI may optimize complex PCI stent deployment and lower MACE; leaves open routine adoption pending dedicated randomized trial confirmation.
Abstract
Coronary angiography has historically served as the gold standard for diagnosis of coronary artery disease and guidance of percutaneous coronary intervention (PCI). Adjunctive use of contemporary intravascular imaging (IVI) technologies has emerged as a complement to conventional angiography-to further characterize plaque morphology and optimize the performance of PCI. IVI has utility for preintervention lesion and vessel assessment, periprocedural guidance of lesion preparation and stent deployment, and postintervention assessment of optimal endpoints and exclusion of complications. The role of IVI in reducing major adverse cardiac events in complex lesion subsets is emerging, and further studies evaluating broader use are underway or in development. This paper provides an overview of currently available IVI technologies, reviews data supporting their utilization for PCI guidance and optimization across a variety of lesion subsets, proposes best practices, and advocates for broader use of these technologies as a part of contemporary practice.
Discussion
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Cite This Study
Truesdell et al. (2023) conducted a review in Coronary artery disease. Intravascular imaging (IVI) vs. Conventional angiography was evaluated. Intravascular imaging provides valuable adjunctive utility to conventional angiography for optimizing percutaneous coronary intervention across various complex lesion subsets.