Intracoronary Imaging to Guide and Optimize: From Seeing Is Believing to Imaging Is Knowing

Intracoronary imaging has the capability of accurately measuring vessel and stenosis dimensions, assessing vessel integrity, characterising lesion morphology and guiding optimal percutaneous coronary intervention (PCI). Coronary angiography used to detect and assess coronary stenosis severity has limitations. The 2D nature of fluoroscopic imaging provides lumen profile only and the assessment of coronary stenosis by visual estimation is subjective and prone to error. Performing PCI based on coronary angiography alone is inadequate for determining key metrics of the vessel such as dimension, extent of disease, and plaque distribution and composition. The advent of intracoronary imaging has offset the limitations of angiography and has shifted the paradigm to allow a detailed, objective appreciation of disease extent and morphology, vessel diameter, stent size and deployment and healing after PCI. It has become an essential tool in complex PCI, including rotational atherectomy, in follow-up of novel drug-eluting stent platforms and understanding the pathophysiology of stent failure after PCI (e.g. following stent thrombosis or in-stent restenosis). In this review we look at the two currently available and commonly used intracoronary imaging tools – intravascular ultrasound and optical coherence tomography – and the merits of each.

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Role of Intracoronary Imaging in Plaque Identification

Case Medical Research ◽

10.31525/ct1-nct03953040 ◽

2019 ◽

Author(s):

Keyword(s):

Intracoronary Imaging

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Adjunctive intracoronary imaging

10.36866/pn.95.36 ◽

2014 ◽

pp. 36-39

Author(s):

Kalpa De Silva Ashford ◽

Philippa Howlett ◽

Fiona Hatch ◽

Michael Mahmoudi

Keyword(s):

Intracoronary Imaging

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Contemporary approaches to bifurcation stenting

JRSM Cardiovascular Disease ◽

10.1177/2048004021992190 ◽

2021 ◽

Vol 10 ◽

pp. 204800402199219

Author(s):

Claire E Raphael ◽

Peter D O’Kane

Keyword(s):

Percutaneous Coronary Intervention ◽

Coronary Intervention ◽

Stent Design ◽

Cardiac Events ◽

Balloon Inflation ◽

Intracoronary Imaging ◽

Percutaneous Coronary ◽

Bifurcation Stenting ◽

Bifurcation Lesions ◽

Provisional Stenting

Bifurcation lesions are common and associated with higher risks of major cardiac events and restenosis after percutaneous coronary intervention (PCI). Treatment requires understanding of lesion characteristics, stent design and therapeutic options. We review the evidence for provisional vs 2-stent techniques. We conclude that provisional stenting is suitable for most bifurcation lesions. We detail situations where a 2-stent technique should be considered and the steps for performing each of the 2-step techniques. We review the importance of lesion preparation, intracoronary imaging, proximal optimization (POT) and kissing balloon inflation

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Long-term follow-up of therapeutic efficacy of everolimus-eluting bioresorbable vascular scaffold in comparison to everolimus-eluting stent in treatment of chronic total occlusion guided by intracoronary imaging

The Egyptian Heart Journal ◽

10.1186/s43044-020-00104-x ◽

2020 ◽

Vol 72 (1) ◽

Author(s):

Mohammad Abdallah Eltahlawi ◽

Abdel-Aziz Fouad Abdel-Aziz ◽

Abdel-Salam Sherif ◽

Khalid Abdel-Azeem Shokry ◽

Islam Elsayed Shehata

Keyword(s):

Chronic Total Occlusion ◽

Bioresorbable Vascular Scaffold ◽

Total Occlusion ◽

Intracoronary Imaging ◽

Group I ◽

Significant Difference ◽

Vascular Scaffold ◽

Long Term Follow Up

Abstract Background We hypothesized that 1st generation everolimus-eluting bioresorbable vascular scaffold (BVS) stent associated with less complication and less restenosis rate than everolimus-eluting stent (EES) in chronic total occlusion (CTO) recanalization guided by intracoronary imaging. Therefore, we aimed to assess the safety and performance of BVS stent in CTO revascularization in comparison to EES guided by intracoronary imaging. Our prospective comparative cross-sectional study was conducted on 60 CTO patients divided into two groups according to type of stent revascularization: group I (EES group): 40 (66.7%) patients and group II (BVS group): 20 (33.3%) patients. All patients were subjected to history taking, electrocardiogram (ECG), echocardiography, laboratory investigation, stress thallium study to assess viability before revascularization. Revascularization of viable CTO lesion guided by intracoronary imaging using optical coherence tomography (OCT). Then, long-term follow-up over 1 year clinically and by multi-slice CT coronary angiography (MSCT). Our clinical and angiographic endpoints were to detect any clinical or angiographic complications during the follow-up period. Results At 6 months angiographic follow-up, BVS group had not inferior angiographic parameters but without statistically significant difference (p = 0.566). At 12 months follow-up, there was no difference at end points between the two groups (p = 0.476). No differences were found at angiographic or clinical follow-up between BVS and EES. Conclusion This study shows that 1st generation everolimus-eluting BVS is non-inferior to EES for CTO revascularization. Further studies are needed to clearly state which new smaller footprint BVS, faster reabsorption, magnesium-based less thrombogenicity, and advanced mechanical properties is under development. We cannot dismiss the efficacy and safety of new BVS technology. Trial registration ZU-IRB#2498/3-12-2016 Registered 3 December 2016, email: [email protected]

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