Role of Intravascular Imaging in Primary PCI

Excerpt

Primary percutaneous coronary intervention (PPCI) is always targeted on the angiographically identified culprit lesion. However, the actual culprit lesion may not compromise the lumen and can be located proximally or distally to the angiographic target lesion. As a result, the risk of incomplete lesion coverage can be high when the PPCI is guided solely by angiography. Furthermore, stent implantation must be optimized, as incomplete apposition and/or edge dissection may result in in-stent restenosis or acute thrombotic events. Thus, invasive coronary imaging using intravascular ultrasound or optical coherence tomography can be useful to guide the PPCI procedure by locating the true culprit lesion and may lead to better stent coverage of the lesion. Besides, invasive imaging also helps to resolve diagnostic uncertainty and to identify the mechanisms underlying acute events.