Emerging Hybrid Intracoronary Imaging Technologies and Their Applications in Clinical Practice and Research (JACC Cardiovascular Interventions September 2024)-Article: Emerging Hybrid Intracoronary Imaging Technologies and Their Applications in Clinical Practice and Research

Article: Emerging Hybrid Intracoronary Imaging Technologies and Their Applications in Clinical Practice and Research

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This state-of-the-art review evaluates emerging hybrid intracoronary imaging technologies and their applications in clinical practice and research. The primary focus is on intravascular ultrasound (IVUS) and optical coherence tomography (OCT), which are increasingly used for diagnosing acute coronary syndromes, assessing coronary stenosis, guiding percutaneous coronary interventions (PCI), and identifying high-risk plaques. However, their limitations, such as restricted effectiveness in detecting vulnerable plaques, have led to the development of multimodality imaging catheters that combine two or three complementary imaging technologies for a more comprehensive assessment of vessel wall pathology and improved PCI guidance.<br /><br />Prototypes of hybrid imaging catheters, including combinations like IVUS-NIRS (near-infrared spectroscopy), IVUS-OCT, and others, have demonstrated promising results in both clinical and postmortem studies. These combined systems can more accurately characterize plaque features and guide PCI by providing detailed imaging of the vessel wall.<br /><br />The review discusses the evolution and available types of hybrid intracoronary imaging systems, emphasizing their potential to improve outcomes in various clinical scenarios. These systems could enhance PCI guidance, detect vulnerable plaques more effectively, and provide better assessment of endovascular devices and emerging therapies targeting atherosclerosis.<br /><br />Standalone IVUS and OCT have limitations, such as moderate predictive values for clinical events within 2-4 years. Advanced hybrid technologies like NIRS, NIRF (near-infrared fluorescence), FLIm (fluorescence lifetime imaging), and IVPA (intravascular photoacoustic) integrated with IVUS or OCT offer improved diagnostic capabilities. These advanced techniques allow for the detection of specific plaque features like lipid content, calcified tissue, and microvessels, providing comprehensive vessel pathology evaluation.<br /><br />The review highlights the importance of large-scale studies to determine the clinical utility of hybrid imaging technologies in guiding revascularization, vulnerable plaque detection, and risk stratification. It also notes the current underuse of intravascular imaging in PCI in the U.S. and potential barriers to broader adoption, such as the need for specialized training, longer procedural times, higher costs, and incomplete reimbursement.<br /><br />In conclusion, hybrid intracoronary imaging represents a significant advancement over standalone imaging modalities, offering enhanced diagnostic and therapeutic capabilities in managing coronary artery disease.

Keywords

hybrid intracoronary imaging

intravascular ultrasound

optical coherence tomography

percutaneous coronary interventions

vulnerable plaques

multimodality imaging catheters

IVUS-NIRS

NIRF

FLIm

IVPA