Imaging in Coronary Interventions

Coronary angiography has historically served as the gold standard for diagnosis of coronary artery disease and guidance of percutaneous coronary intervention (PCI), but the evolution of PCI would not have been possible without intravascular imaging which provides unique insights about coronary artery pathology.

Over the last 30 years IVUS and, more recently, optical coherence tomography (OCT) have been extensively used to examine the extent and severity of coronary artery disease (CAD), guide PCI in complex lesions, and assess the performance of emerging devices introduced to treat CAD. In this section, you will find a selection of resources showing the use of imaging in real-life scenarios.

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Imaging to the rescue

11 Dec 2025 – From GulfPCR-GIM 2025

This session highlighted the pivotal role of advanced intracoronary imaging techniques, particularly OCT, in complex case management such as in-stent restenosis and thrombus evaluation. Through real-world cases, it demonstrated how imaging complements physiology to guide therapeutic decisions, including the use of drug-coated balloons beyond native coronary...

Seeing is believing: OCT-guided calcium modification in complex PCI

10 Dec 2025 – From GulfPCR-GIM 2025

This session focuses on the pivotal role of Optical Coherence Tomography (OCT) in managing complex calcified coronary artery lesions. It covers the indications for calcium modification techniques such as orbital atherectomy, guided by OCT imaging, and demonstrates the optimization of drug-eluting stent (DES) expansion in challenging...

Seeing is believing: OCT-guided calcium modification in complex PCI

Validation of intravascular ultrasound-defined optimal stent expansion criteria for favorable 1-year clinical outcomes

17 Nov 2025

This individual patient data analysis of the three largest RCTs evaluating IVUS-guided stent optimisation showed that an MSA > 5.5 mm2 was associated with reduced TVF at one year. 

Ruxandra Sava

Reviewer

Ruxandra Sava
Nicola Ryan

Reviewer

Nicola Ryan
Validation of IVUS-defined optimal stent expansion criteria for favorable 1-year clinical outcomes

What are the key steps in pre procedural assessment for successful LAA closure?

16 Nov 2025 – From PCR London Valves 2025

Lorenz Räber and Kasper Korsholm highlight why pre-procedural imaging—particularly cardiac CT—has become essential for successful left atrial appendage occlusion (LAAO). They explain that the LAA is highly variable between patients, making detailed planning crucial for safety, device selection, and optimal procedural results.

This interview was filmed at...

What are the key steps in pre procedural assessment for successful LAA closure?

iFR versus angiography-guided CABG: 3-year results of the iCABG randomised trial

31 Oct 2025

Alex Sticchi provides his take on the iCABG trial presented by Rasa Ordiene at TCT 2025, in San Francisco.

Alessandro Sticchi

Author

Alessandro Sticchi
iFR versus angiography-guided CABG: 3-year results of the iCABG randomized trial

Precision in plaque management: hybrid techniques and IVUS imaging for optimal outcomes

11 Oct 2025 – From AICT-AsiaPCR 2025

This session offers an in-depth exploration of precision plaque management strategies through hybrid lesion preparation techniques and advanced intravascular ultrasound (IVUS) imaging. It emphasizes the synergistic use of drug-coated balloons and drug-eluting stents to optimize PCI outcomes. Participants will gain a deeper understanding of how cutting...

Precision in plaque management: hybrid techniques and IVUS imaging for optimal outcomes

Complex non left main bifurcation - LIVE Case

11 Oct 2025 – From AICT-AsiaPCR 2025

A 55-year-old male with no risk factors presented with an anterior STEMI treated by primary PCI of the LAD. Coronary angiography revealed triple-vessel disease. The RCA was treated one month later with a DCB, and the bifurcation LCX/OM (Medina 1,1,1) was treated during the live procedure....

Complex non left main bifurcation - LIVE Case

Left main PCI - LIVE Case

10 Oct 2025 – From AICT-AsiaPCR 2025

A 78-year-old male with a history of LAD PCI in 1997 presented with an NSTEMI three months earlier due to diffuse three-vessel calcified disease, including: distal LM stenosis, severe mid and distal disease of a dominant RCA, and LAD in-stent restenosis. LV function was normal. He...

Left main PCI - LIVE Case

Optical coherence tomography- vs angiography-guided coronary stent implantation in calcified lesions: the ILUMIEN IV trial

28 Aug 2025

In the overall population (n = 2,114), there was a significant interaction between the effect of randomisation to OCT guidance vs angiography guidance in lesions with moderate/severe calcification (n = 1,082) vs no/mild calcification (n = 1,032) on the 2-year rate of TVF (Pinteraction = 0.01).

Reviewer

Salvatore Brugaletta
OCT- vs angiography-guided coronary stent implantation in calcified lesions: the ILUMIEN IV trial

PCI for complex bifurcation disease - LIVE Case

23 May 2025 – From EuroPCR 2025

A 60-year-old male patient presented with an inferior STEMI one month ago, which was treated with RCA and LCx PCI. He was referred for LAD/diagonal PCI. The LV function was reduced (EF 45 %). The team performed a DK crush PCI, guided by IVUS.

LIVE Educational Case...

PCI for complex bifurcation disease - LIVE Case