Recent Advances in Coronary Intravascular Imaging and Computational Methods

Coronary artery disease remains a leading cause of global mortality, and while intravascular imaging has improved percutaneous coronary intervention outcomes, significant gaps remain in resolution, functional assessment, and integration of molecular information. This review covers technological advances in clinically established (intravascular ultrasound, optical coherence tomography, near-infrared spectroscopy) and emerging (near-infrared fluorescence, fluorescence lifetime imaging, intravascular photoacoustic imaging) imaging modalities, as well as computational methods including artificial intelligence and biomechanical modeling, with emphasis on studies from January 2015 to June 2025. Literature was retrieved from PubMed, Embase, and Web of Science, prioritizing human studies, clinical trials, and recent consensus documents. Key findings include: hybrid intravascular ultrasound-optical coherence tomography and optical coherence tomography-fluorescence lifetime imaging systems have entered first-in-human studies; artificial intelligence-based plaque characterization achieves diagnostic accuracy comparable to expert readers; and computational physiology enables functional assessment from a single imaging pullback. These advances establish a unified imaging paradigm that may enable simultaneous anatomical, compositional, and functional coronary assessment, although widespread clinical adoption will require standardized validation and seamless integration into interventional workflows.