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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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

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

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

PCI for complex left main disease - LIVE Case

23 May 2025 – From EuroPCR 2025

An 82-year-old male patient with a history of STEMI and diagonal PCI (2004) presented with stable angina (CCS 2). CT imaging revealed 2 severe LAD stenoses (at the ostium and mid part), and a severe bifurcation stenosis at the Cx/OM1 confirmed by angiography. A staged PCI...

PCI for complex left main disease - LIVE Case

Navigating complexity in high-risk patients with multivessel disease undergoing PCI

23 May 2025 – From EuroPCR 2025

This educational session focuses on navigating the complexities of PCI in high-risk patients with multivessel disease. Learn the roles of imaging and physiology, low-contrast PCI techniques, and optimal strategies for patients with concomitant aortic stenosis, illustrated through detailed case discussions.

Navigating complexity in high-risk patients with multivessel disease undergoing PCI

Vulnerable plaque PCI after PREVENT

22 May 2025 – From EuroPCR 2025

This interview with Michael Haude and Thomas Cuisset explores findings from the PREVENT trial, which included over 1,600 patients with vulnerable, physiologically non-significant plaques identified by IVUS.

Patients were randomised to optimal medical therapy (OMT) alone or OMT plus preventive PCI. While the composite endpoint favoured the PCI...

Vulnerable plaque PCI after PREVENT

Integrating CT coronary angiography into your PCI practice

22 May 2025 – From EuroPCR 2025

Integrate CT coronary angiography into your PCI practice to enhance procedural planning and outcomes. This session covers practical CT-based approaches for guiding catheter selection, lesion analysis, and stenting strategy. Learn how to leverage CT imaging to anticipate plaque preparation needs in calcified lesions and optimize catheterization...

Integrating CT coronary angiography into your PCI practice

Beyond angiography: imaging-guided solutions for stent failure

22 May 2025 – From EuroPCR 2025

Stent failure remains a critical challenge in interventional cardiology — but intracoronary imaging can change the outcome. This session goes beyond angiography to examine why stents fail, how to detect underlying causes, and how imaging-guided strategies can help tailor reintervention. Two real-life cases, from complex restenosis...

Beyond angiography: imaging-guided solutions for stent failure