The following are key points to remember from a state-of-the-art review on intravascular imaging (IVI) during percutaneous coronary intervention (PCI):

1. Coronary angiography has historically served as the gold standard for diagnosis of coronary artery disease and guidance of PCI.
2. However, coronary angiography may have limited utility to characterize plaque morphology and optimize outcomes of PCI.
3. Adjunctive use of contemporary IVI technologies has emerged as a complement to conventional angiography to further characterize plaque morphology and optimize the performance of PCI.
4. IVI has clinical utility for preintervention lesion and vessel assessment, periprocedural guidance of lesion preparation and stent deployment, and postintervention assessment of optimal endpoints and exclusion of complications.
5. During PCI procedures, the greater resolution of optical coherence tomography (OCT) enables precise location of side branches, wire location, and stent visualization (including assessments of malapposition), with greater sensitivity to detect intimal/medial dissections compared with intravascular ultrasound (IVUS), although both techniques are superior to angiography alone.
6. IVI also has important utility as a research tool for evaluating the mechanisms of action, efficacy, and safety of new pharmacological agents and interventional devices to include antiatherosclerotic drugs, drug-eluting balloons, newer-generation drug-eluting stents, and bioresorbable scaffolds.
7. Further in-laboratory IVI workflow optimizations can be made, and the ability to automate measurements and/or image interpretation using artificial intelligence and other technologies are potential future ways to overcome current barriers to use.
8. The use of multimodality IVI systems, potentially combining either multiple imaging systems and/or physiological lesion assessment, may hold promise in further optimizing lesion assessment and PCI optimization.
9. The role of IVI in reducing major adverse cardiac events in complex lesion subsets is emerging, and studies evaluating broader use are underway or in development.
10. Finally, additional prospective studies are needed to clarify the role of IVI across the spectrum of lesion types in patients undergoing PCI.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Atherosclerotic Disease (CAD/PAD), Interventions and Coronary Artery Disease, Interventions and Imaging, Angiography, Echocardiography/Ultrasound, Nuclear Imaging

Keywords: Absorbable Implants, Artificial Intelligence, Coronary Angiography, Coronary Artery Disease, Diagnostic Imaging, Drug-Eluting Stents, Myocardial Ischemia, Percutaneous Coronary Intervention, Plaque, Atherosclerotic, Stents, Ultrasonography, Interventional, Tomography, Optical Coherence

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