Authors
Carlo Di Mario, Giulia Nardi, Niccolò Ciardetti, Alessio Mattesini
Published in
European heart journal. Oct 06, 2026. Epub Oct 06, 2026.
Abstract
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.
PMID:
42834703
Bibliographic data and abstract were imported from PubMed on 06 Oct 2026.
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