[Intracoronary imaging in women]

Coronary artery disease remains the leading cause of mortality among women, despite a persistent underestimation of its clinical impact. Intracoronary imaging techniques (ICI), such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT), have emerged as valuable tools to complement angiography, especially in women, whose pathophysiological mechanisms are often atypical.

To analyse current data on the use of ICI in women and highlight its benefits, limitations, and sex-specific considerations.

Narrative review of recent literature, including observational studies, post-hoc analyses of randomized trials, and registries focusing on IVUS and OCT use in women.

Women tend to have smaller coronary arteries, less extensive atherosclerotic disease, and distinct plaque composition, with a predominance of erosions over ruptures. These characteristics are poorly assessed by angiography alone, reinforcing the value of ICI, particularly in cases of MINOCA and spontaneous coronary artery dissection (SCAD). Despite demonstrated clinical benefits, ICI remains underused in women, with lower penetration into routine practice and underrepresentation in clinical trials. Complications related to intracoronary imaging are rare and comparable between genders, if precautions specific to female anatomy are observed.

ICI represents a significant yet underutilized opportunity to improve cardiovascular outcomes in women. Better integration of this technology into diagnostic and therapeutic strategies, combined with more gender-specific research, is essential to reduce persistent disparities in care.