Key result
Intravascular imaging-guided PCI significantly reduces target lesion failure and cardiac mortality versus angiography guidance.
Why the study?
Intravascular imaging techniques have evolved significantly and demonstrated clinical benefits over angiography-guided PCI, yet remain underused in practice.
Does intravascular imaging-guided PCI reduce adverse clinical outcomes compared to angiography-guided approaches?
Does intravascular imaging-guided PCI reduce adverse clinical outcomes compared to angiography-guided approaches?
The evolution and robust clinical evidence of intravascular imaging have established it as a critical tool for optimizing complex PCI, resulting in Class I, Level A guideline recommendations despite current underutilization.
Initially developed to overcome the limitations of angiography in visualizing plaque morphology, intravascular ultrasound and optical coherence tomography have advanced dramatically in resolution, acquisition speed, and analytical automation. These techniques now provide detailed, real-time assessment of coronary artery structure, enabling precise stent sizing, calcium characterization, and optimization of percutaneous coronary interventions. Clinical trials and meta-analyses demonstrated that intravascular imaging-guided PCI significantly reduces restenosis, thrombosis, target lesion failure, and cardiac mortality compared with angiography-guided approaches. These achievements underpin the current Class I, Level A recommendations for intravascular imaging-guidance of complex PCI in the most recent ESC and ACC/AHA/SCAI guidelines. Intravascular imaging has also become instrumental in studying atherosclerosis regression, plaque vulnerability, and the effects of lipid-lowering therapies such as statins and PCSK9 inhibitors, allowing the implementation of personalized prevention and intervention strategies. Intravascular imaging remains grossly underused in clinical practice but better reimbursement, improved and mandatory training and the integration of artificial intelligence for image interpretation may facilitate a wider application.
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Mario et al. (2026) conducted a review in Coronary artery disease. Intravascular imaging-guided PCI vs. Angiography-guided approaches was evaluated. Intravascular imaging-guided PCI significantly reduces restenosis, thrombosis, target lesion failure, and cardiac mortality compared with angiography-guided approaches.
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