Improving PCI Outcomes Using Postprocedural Physiology and Intravascular Imaging

Area of Science:

• Interventional Cardiology
• Cardiovascular Imaging
• Medical Device Technology

Background:

• Clinical outcomes after percutaneous coronary intervention (PCI) are improving, but long-term target vessel failure remains a concern.
• Intravascular imaging and physiological indexes can improve PCI outcomes, yet their routine use is limited.
• Achieving optimal intravascular dimensions and minimizing vascular injury are essential for truly improving patient outcomes post-PCI.

Purpose of the Study:

• To provide an overview of current tools and techniques for identifying suboptimal PCI.
• To guide the application of intravascular imaging and physiological indexes for improved patient outcomes.
• To discuss the recognition and treatment of stent- and vessel-related anomalies after PCI.

Main Methods:

• Review of intravascular imaging modalities (e.g., IVUS, OCT).
• Assessment of physiological indexes (e.g., FFR, iFR).
• Discussion of emerging technologies like angiography-derived coronary physiology and hybrid imaging catheters.

Main Results:

• A broad spectrum of stent- and vessel-related anomalies can occur post-PCI, detectable by imaging and physiological assessments.
• Not all identified anomalies require treatment; a nuanced understanding is necessary.
• Optimal intravascular dimensions and minimal vascular injury are key targets for reducing long-term risks.

Conclusions:

• Effective use of intravascular imaging and physiological assessment requires knowledge of potential anomalies and when to intervene.
• Newer modalities offer promising advancements in defining and optimizing PCI results.
• Targeting optimal intravascular dimensions and managing anomalies are critical for reducing target vessel failure after PCI.