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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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

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

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

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

The role of DCB in non-left main true bifurcations

22 May 2025 – From EuroPCR 2025

This session offers a detailed exploration of drug-coated balloon (DCB) use in non-left main true bifurcation lesions. Learn to define suitable lesion characteristics for provisional stenting, understand stepwise procedural strategies minimizing implanted material, and appreciate the role of intravascular imaging in assessing bifurcation complexity and optimizing...

The role of DCB in non-left main true bifurcations

Imaging makes it clear!

22 May 2025 – From EuroPCR 2025

Explore the critical role of intravascular imaging in interventional cardiology through real-world cases. This session highlights the value of intravascular ultrasound (IVUS) in avoiding unnecessary stenting in STEMI patients, the application of optical coherence tomography (OCT) in complex scenarios, and the management of calcified lesions with...

Imaging makes it clear!

A mindset shift in the cathlab: leveraging contemporary technologies for planning and guiding PCI in complex patients

22 May 2025 – From EuroPCR 2025

This session examines evolving catheterisation lab workflows, highlighting how integrated imaging, physiology, and procedural strategies are reshaping PCI practices. Speakers emphasize the importance of advanced pre-procedural planning using modalities such as intravascular ultrasound (IVUS) to optimise stent deployment, and cardiac computed tomography angiography (CCTA) to improve diagnosis...

A mindset shift in the cathlab: leveraging contemporary technologies for planning and guiding PCI in complex patients