Intravascular Imaging Versus Physiology Assessment for Intermediate Lesions During PCI

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Imaging

Background:

• Coronary artery disease (CAD) remains a leading cause of mortality worldwide.
• Conventional angiography has limitations in assessing intermediate coronary lesion severity and plaque morphology.
• Accurate assessment is crucial for optimal revascularization strategies.

Purpose of the Study:

• To review and contrast evidence for physiology and imaging guidance in assessing intermediate coronary lesions during PCI.
• To provide insights into the application of these tools in specific lesion subsets.
• To link anatomical stenosis with functional consequences on myocardial perfusion.

Main Methods:

• Review of current literature on intravascular ultrasonography (IVUS), optical coherence tomography (OCT), fractional flow reserve (FFR), and instantaneous wave-free ratio (iFR).
• Comparison of diagnostic accuracy and clinical utility of imaging versus physiology guidance.
• Analysis of evidence for intermediate lesion assessment in PCI.

Main Results:

• Physiology (FFR, iFR) and imaging (IVUS, OCT) tools significantly enhance the assessment of intermediate coronary lesions.
• These modalities provide functional and morphological data beyond conventional angiography.
• Guidance by these tools can refine revascularization decisions, improving patient outcomes.

Conclusions:

• Adjunctive physiology and imaging guidance are essential for managing intermediate coronary lesions in PCI.
• These techniques bridge the gap between anatomical stenosis and functional significance.
• Tailored use of IVUS, OCT, FFR, and iFR optimizes PCI strategies for individual lesion subsets.