The Present and Future
Review Topic of the Week
Clinical Utility of Intravascular Imaging and Physiology in Coronary Artery Disease

https://doi.org/10.1016/j.jacc.2014.01.015Get rights and content
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Abstract

Intravascular imaging and physiology techniques and technologies are moving beyond the framework of research to inform clinical decision making. Currently available technologies and techniques include fractional flow reserve; grayscale intravascular ultrasound (IVUS); IVUS radiofrequency tissue characterization; optical coherence tomography, the light analogue of IVUS; and near-infrared spectroscopy that detects lipid within the vessel wall and that has recently been combined with grayscale IVUS in a single catheter as the first combined imaging device. These tools can be used to answer questions that occur during daily practice, including: Is this stenosis significant? Where is the culprit lesion? Is this a vulnerable plaque? What is the likelihood of distal embolization or periprocedural myocardial infarction during stent implantation? How do I optimize acute stent results? Why did thrombosis or restenosis occur in this stent? One of the legacies of coronary angiography is to presume that one technique will answer all of these questions; however, that often has been proved inaccurate in contemporary practice.

Key Words

fractional flow reserve
intravascular ultrasound
near-infrared spectroscopy
optical coherence tomography
radiofrequency IVUS

Abbreviations and Acronyms

DES
drug-eluting stent(s)
FFR
fractional flow reserve
ISR
in-stent restenosis
IVUS
intravascular ultrasound
LMCA
left main coronary artery
MI
myocardial infarction
MLA
minimum lumen area
OCT
optical coherence tomography
TCFA
thin-cap fibroatheroma
VH
virtual histology

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Dr. Mintz has received speakers’ bureau and fellowship support from Boston Scientific; and is a consultant to and receives research support from Volcano Corporation and InfraReDx, Inc.