Post-PCI Physiology and Intravascular Imaging
- van Zandvoort LJ, Ali Z, Kern M, van Mieghem NM, Mintz GS, Daemen J.
- Improving PCI Outcomes Using Postprocedural Physiology and Intravascular Imaging. JACC Cardiovasc Interv 2021;14:2415-2430.
The following are key points to remember from this state-of-the-art review on improving percutaneous coronary intervention (PCI) outcomes using postprocedural physiology and intravascular imaging:
- Although clinical outcomes after PCI are improving, the long-term risk for target vessel failure remains concerning.
- The application of intravascular imaging and physiological indexes significantly improves outcomes; however, their routine use in practice remains limited.
- Of note, merely using these modalities is not enough, and to truly improve patient outcomes, optimal intravascular dimensions with minimal vascular injury should be targeted.
- Recent studies have demonstrated that stent optimization through intravascular imaging and coronary physiology after stenting can affect clinical outcomes.
- The body of evidence is convincing on the benefit of intravascular ultrasound (IVUS), optical coherence tomography (OCT), and fractional flow reserve (FFR) or instantaneous wave-free ratio (iFR) for PCI optimization.
- Newer indexes such as three-dimensional quantitative coronary angiography–based FFR and nonhyperemic pressure ratios have the potential to further advance the field.
- Each technology has its own benefits and drawbacks and requires dedicated training to be able to appreciate the wide spectrum of stent- and vessel-related issues that can be encountered post-PCI.
- This goal can be achieved only by accurate procedural planning, adequate assessment of pre- and post-PCI imaging and physiology, and treating those remaining issues that might cause future events.
Clinical Topics: Cardiovascular Care Team, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Vascular Medicine, Interventions and Imaging, Interventions and Vascular Medicine, Angiography, Echocardiography/Ultrasound, Nuclear Imaging
Keywords: Coronary Angiography, Diagnostic Imaging, Fractional Flow Reserve, Myocardial, Myocardial Ischemia, Percutaneous Coronary Intervention, Physiology, Secondary Prevention, Stents, Tomography, Optical Coherence, Ultrasonography, Ultrasonography, Interventional, Vascular System Injuries
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