A Review of the Clinical Utility of Intravascular Ultrasound and Optical Coherence Tomography in the Assessment and Treatment of Coronary Artery Disease

Coronary artery disease remains one of the leading causes of morbidity and mortality in the United States. As a medical society, we continue to search for ways to better treat coronary artery disease and prevent acute coronary syndrome (ACS). As it stands, only statins and antiplatelet agents have been proven to significantly reduce the occurrence of ACS. A histopathological understanding of the pathogenesis of ACS has provided insight into the importance of plaque morphology. Therefore, it has been proposed that increasing the ability to detect true vulnerable, "at-risk" lesions, would foster the use of percutaneous coronary intervention as a means for the prevention of ACS. There are now several different imaging modalities to help cardiologists stratify plaque stability. These include, but are not limited to, angioscopy, magnetic resonance angiography, intravascular ultrasound (IVUS), optical coherence tomography (OCT), and near-infrared fluorescence. To date, the most studied and frequently used in clinical trials are IVUS and OCT. Following a brief background discussion of IVUS and OCT, we will objectively evaluate each modality's ability to detect specific morphological characteristics. This article will also discuss IVUS and OCT's clinical utility with regard to proper stent placement and follow-up after percutaneous coronary interventions.