Guiding Coronary Interventions with Light and Sound

Abstract

A large majority of patients presenting with acute coronary syndrome is treated by stent implantation, in a procedure called percutaneous coronary intervention (PCI). Such interventions have a high acute success rate, but see a persistent 10-15% repeat revascularization rate due to stent failure or symptoms arising from different sites in the coronary circulation. Intravascular imaging guidance brings a marked improvement in outcome measures (including reduced reintervention). In Europe and the US, however, intravascular imaging is used in only a small fraction of PCIs, due to factors like cost, time, increased X-ray and contrast use, and the required operator expertise. In this overview, I will discuss how these perceived limitations of catheter-based interventional imaging can be ameliorated or overcome with technical improvements to the imaging technologies we apply. Highlighting developments in intravascular optical coherence tomography and photoacoustic imaging, I will focus on how advanced acquisition strategies can improve imaging speed and image contrast, with the aim to make intravascular imaging easier to use and interpret.