Tạp chí Tim mạch học Việt Nam

Article detail

Article detail description

Home
BÀI TỔNG QUAN. Issue: Số 117

Intravascular imaging in percutaneous coronary intervention: A comprehensive overview

Published: September 30, 2025
Views: 70

Abstract

Advancements in interventional techniques and optimal medical therapy have significantly improved clinical outcomes for patients undergoing percutaneous coronary intervention (PCI). At the forefront of these developments is intravascular imaging (IVI). Evidence has demonstrated that IVI-guided PCI reduces the risk of death, recurrent myocardial infarction, target lesion revascularization, and stent thrombosis compared with angiography guidance alone. Reflecting this, the latest 2024 European Society of Cardiology (ESC) guidelines on chronic coronary syndromes and the 2025 American College of Cardiology/American Heart Association (ACC/AHA) guidelines on acute coronary syndromes both provide a Class I recommendation for using IVI in complex PCI. This review summarizes the latest guideline recommendations for the role of intravascular imaging in PCI, while also discussing scenarios not explicitly addressed in current guidelines.

References

1.
Lawton JS, Tamis-Holland JE, Bangalore S, et al. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022;145(3):e4-e17. doi:10.1161/CIR.0000000000001039
2.
Vrints C, Andreotti F, Koskinas KC, et al. 2024 ESC Guidelines for the management of chronic coronary syndromes. Eur Heart J. 2024;45(36):3415-3537. doi:10.1093/eurheartj/ehae177
3.
Li X, Ge Z, Kan J, et al. Intravascular ultrasound-guided versus angiography-guided percutaneous coronary intervention in acute coronary syndromes (IVUS-ACS): a two-stage, multicentre, randomised trial. Lancet. 2024;403(10439):1855-1865. doi:10.1016/S0140-6736(24)00282-4
4.
Byrne RA, Rossello X, Coughlan JJ, et al. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J. 2023;44(38):3720-3826. doi:10.1093/eurheartj/ehad191
5.
Jia H, Dai J, He L, et al. EROSION III: A Multicenter RCT of OCT-Guided Reperfusion in STEMI With Early Infarct Artery Patency. JACC Cardiovasc Interv. 2022;15(8):846-856. doi:10.1016/j.jcin.2022.01.298
6.
Rao SV, O'Donoghue ML, Ruel M, et al. 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2025;151(13):e771-e862. doi:10.1161/CIR.0000000000001309
7.
Stone GW, Christiansen EH, Ali ZA, et al. Intravascular imaging-guided coronary drug-eluting stent implantation: an updated network meta-analysis. Lancet. 2024;403(10429):824-837. doi:10.1016/S0140-6736(23)02454-6
8.
Giacoppo D, Laudani C, Occhipinti G, et al. Coronary Angiography, Intravascular Ultrasound, and Optical Coherence Tomography for Guiding of Percutaneous Coronary Intervention: A Systematic Review and Network Meta-Analysis. Circulation. 2024;149(14):1065-1086. doi:10.1161/CIRCULATIONAHA.123.067583
9.
Neumann FJ, Sousa-Uva M. 'Ten commandments' for the 2018 ESC/EACTS Guidelines on Myocardial Revascularization. Eur Heart J. 2019;40(2):79-80. doi:10.1093/eurheartj/ehy855
10.
Shlofmitz E, Case BC, Chen Y, et al. Waksman In-Stent Restenosis Classification: A Mechanism-Based Approach to the Treatment of Restenosis. Cardiovasc Revasc Med. 2021;33:62-67. doi:10.1016/j.carrev.2021.06.004
11.
Xhepa E, Bresha J, Joner M, et al. Clinical outcomes by optical characteristics of neointima and treatment modality in patients with coronary in-stent restenosis. EuroIntervention. 2021;17(5):e388-e395. doi:10.4244/EIJ-D-20-00662
12.
Tian NL, Gami SK, Ye F, et al. Angiographic and clinical comparisons of intravascular ultrasound- versus angiography-guided drug-eluting stent implantation for patients with chronic total occlusion lesions: two-year results from a randomised AIR-CTO study. EuroIntervention. 2015;10(12):1409-1417. doi:10.4244/EIJV10I12A245
13.
Kim BK, Shin DH, Hong MK, et al. Clinical Impact of Intravascular Ultrasound-Guided Chronic Total Occlusion Intervention With Zotarolimus-Eluting Versus Biolimus-Eluting Stent Implantation: Randomized Study. Circ Cardiovasc Interv. 2015;8(7):e002592. doi:10.1161/CIRCINTERVENTIONS.115.002592
14.
Lee JM, Choi KH, Song YB, et al. Intravascular Imaging-Guided or Angiography-Guided Complex PCI. N Engl J Med. 2023;388(18):1668-1679. doi:10.1056/NEJMoa2216607
15.
Shin D, Hong D, Singh M, et al. Intravascular imaging-guided percutaneous coronary intervention for heavily calcified coronary lesions: a systematic review and meta-analysis. Int J Cardiovasc Imaging. 2024;40(8):1653-1659. doi:10.1007/s10554-024-03150-7
16.
Gao XF, Ge Z, Kong XQ, et al. Intravascular Ultrasound vs Angiography-Guided Drug-Coated Balloon Angioplasty: The ULTIMATE Ⅲ Trial. JACC Cardiovasc Interv. 2024;17(13):1519-1528. doi:10.1016/j.jcin.2024.04.014
17.
Park SJ, Ahn JM, Kang DY, et al. Preventive percutaneous coronary intervention versus optimal medical therapy alone for the treatment of vulnerable atherosclerotic coronary plaques (PREVENT): a multicentre, open-label, randomised controlled trial. Lancet. 2024;403(10438):1753-1765. doi:10.1016/S0140-6736(24)00413-6
18.
Tufaro V, Jaffer FA, Serruys PW, et al. Emerging Hybrid Intracoronary Imaging Technologies and Their Applications in Clinical Practice and Research. JACC Cardiovasc Interv. 2024;17(17):1963-1979. doi:10.1016/j.jcin.2024.07.007
19.
Lee JM, Lee SY, Kwon W, et al. Intravascular Imaging Predictors Associated With Cardiovascular Events After Complex PCIs. Circ Cardiovasc Interv. 2025;18(2):e014920. doi:10.1161/CIRCINTERVENTIONS.124.014920
20.
Lee PH, Hong SJ, Kim HS, et al. Quantitative coronary angiography versus intravascular ultrasound guidance for drug-eluting stent implantation (GUIDE-DES): study protocol for a randomised controlled non-inferiority trial. BMJ Open. 2022;12(1):e052215. doi:10.1136/bmjopen-2021-052215
21.
Ali ZA, Karimi Galougahi K, Maehara A, et al. Outcomes of optical coherence tomography compared with intravascular ultrasound and with angiography to guide coronary stent implantation: one-year results from the ILUMIEN III: OPTIMIZE PCI trial. EuroIntervention. 2021;16(13):1085-1091. doi:10.4244/EIJ-D-20-00498
22.
Ali ZA, Landmesser U, Maehara A, et al. Optical Coherence Tomography-Guided versus Angiography-Guided PCI. N Engl J Med. 2023;389(16):1466-1476. doi:10.1056/NEJMoa2305861
23.
Hong SJ, Kim BK, Shin DH, et al. Effect of Intravascular Ultrasound-Guided vs Angiography-Guided Everolimus-Eluting Stent Implantation: The IVUS-XPL Randomized Clinical Trial. JAMA. 2015;314(20):2155-2163. doi:10.1001/jama.2015.15454
24.
Kang DY, Ahn JM, Yun SC, et al. Optical Coherence Tomography-Guided or Intravascular Ultrasound-Guided Percutaneous Coronary Intervention: The OCTIVUS Randomized Clinical Trial. Circulation. 2023;148(16):1195-1206. doi:10.1161/CIRCULATIONAHA.123.066429
25.
Holm NR, Andreasen LN, Neghabat O, et al. OCT or Angiography Guidance for PCI in Complex Bifurcation Lesions. N Engl J Med. 2023;389(16):1477-1487. doi:10.1056/NEJMoa2307770
26.
Gao XF, Ge Z, Kong XQ, et al. 3-Year Outcomes of the ULTIMATE Trial Comparing Intravascular Ultrasound Versus Angiography-Guided Drug-Eluting Stent Implantation. JACC Cardiovasc Interv. 2021;14(3):247-257. doi:10.1016/j.jcin.2020.10.001

Files

Article Views70
Document Views2
Downloads0
Section BÀI TỔNG QUAN.
Issue Số 117
Pages 7-16