Intravascular Imaging Guidance During Percutaneous Coronary Intervention: Current Evidence and Future Outlook

Purpose of ReviewTo provide the most contemporary evidence, guideline-based recommendations, and future outlook for use of intravascular imaging in percutaneous coronary intervention.Recent FindingsNew randomized controlled trial and registry data support the use of intravascular imaging to improve hard clinical outcomes, particularly in complex lesion subsets. This data most notably prompted the recent 2024 update to the European Society of Cardiology guidelines - elevating intravascular imaging to a class 1A indication for percutaneous coronary intervention in left main, bifurcation, and long lesions.SummaryIntravascular imaging is newly a guideline-based European class 1A recommendation for percutaneous coronary intervention in select complex lesion subsets. While the absolute benefit of intravascular imaging in non-complex lesions is presently unclear, ongoing clinical trial data may ultimately provide evidence to advocate for use in additional clinical settings and perhaps someday all-comer lesions.