Emerging Image-Guided Navigation Techniques for Cardiovascular Interventions: A Scoping Review

Abstract

Background: Image-guided navigation has revolutionized precision cardiac interventions, yet current technologies face critical limitations in real-time guidance and procedural accuracy. Method: Here, we comprehensively evaluate state-of-the-art imaging modalities, from conventional fluoroscopy to emerging hybrid systems, analyzing their applications across coronary, structural, and electrophysiological interventions. Results: We demonstrate that novel approaches combining optical coherence tomography with near-infrared spectroscopy or fluorescence achieve unprecedented plaque characterization and procedural guidance through simultaneous structural and molecular imaging. Our analysis reveals key challenges, including imaging artifacts and resolution constraints, while highlighting recent technological solutions incorporating artificial intelligence and robotics. We show that non-imaging alternatives, such as fiber optic real-shape sensing and electromagnetic tracking, complement traditional techniques by providing real-time navigation without radiation exposure. This paper also discusses the integration of image-guided navigation techniques into augmented reality systems and patient-specific modeling, highlighting initial clinical studies that demonstrate their significant promise in reducing procedural times and improving accuracy. These findings establish a framework for next-generation cardiac interventions, emphasizing the critical role of multimodal imaging platforms enhanced by AI-driven decision support. Conclusions: We conclude that continued innovation in hybrid imaging systems, coupled with advances in automation, will be essential for optimizing procedural outcomes and expanding access to complex cardiac interventions.

Keywords: artificial intelligence; cardiac imaging; image-guided navigation; interventional cardiology; multimodal imaging.

Figure 1

Ultrasound Doppler imaging-guided swarm formation and navigation in blood vessels. (A–C) Three different configurations for magnetic nanoparticle swarm control and manipulation within vasculature, showing how field orientation affects navigation strategy. (D) Formation of nanoparticle chains through magnetic assembly and their targeted delivery capabilities. (E) Comprehensive visualization of swarm behavior under different blood flow conditions using B-mode and Doppler imaging for real-time tracking. This multimodal approach enables precise control of therapeutic delivery while providing continuous feedback on swarm positions relative to vessel boundaries, demonstrating superior navigation in complex vascular environments compared to conventional fluoroscopic guidance. Image reproduced with permission from [17].

Figure 2

A high-resolution optical coherence tomography (OCT) visualization of atherosclerotic plaque morphology. Upper images show raw OCT cross-sections, while lower images include color-coded interpretations of key plaque features. Left panels demonstrate a single-layered plaque structure (blue overlay) with a crescent-shaped morphology characteristic of healed coronary lesions, providing detailed visualization at 10–20 µm resolution. The right panels illustrate a more complex multi-layered plaque (blue and white overlays), indicating previous rupture and healing cycles that increase vulnerability to future events. This level of microstructural detail significantly exceeds the capabilities of other intravascular imaging modalities, enabling the precise assessment of fibrous cap thickness, a critical determinant of plaque stability. Image reproduced with permission from [26].

Figure 3

Multimodal molecular and structural characterization of coronary atherosclerosis using integrated NIRF-IVUS imaging. (a) Longitudinal view of a human coronary artery with a corresponding NIRF signal map showing the heterogeneous distribution of inflammatory activity (high signal in yellow/red). (b–d) Cross-sectional NIRF-IVUS images at different arterial locations with corresponding histopathology, demonstrating the precise co-localization of NIRF signals with inflammatory markers (CD68 and CD31) and lipid-rich regions confirmed by histology (ORO staining). This hybrid imaging approach provides a simultaneous assessment of plaque structure (IVUS) and biological activity (NIRF) at a resolution unattainable by either modality alone, enabling more comprehensive risk stratification than conventional angiography or structural imaging. The integration of molecular and anatomical data in a single catheter platform represents a significant advancement for precision-guided coronary interventions. Image reproduced with permission from [34].

Figure 4

Comprehensive assessment of plaque vulnerability using standalone and hybrid intracoronary imaging modalities. The central schematic illustrates a coronary artery with various plaque features, including a thin fibrous cap, macrophage infiltration, neovascularization, calcification, lipid core, and plaque erosion. Surrounding images demonstrate how specific imaging technologies visualize these features: OCT-NIRS and NIRS-IVUS for lipid detection and cap thickness assessment; OCT-NIRF for inflammatory activity visualization; IVPA-IVUS for neovascularization detection; OCT for calcification identification; and various multimodal approaches for comprehensive plaque characterization. This comparison highlights the complementary nature of different imaging techniques and demonstrates how hybrid approaches provide a more comprehensive assessment than single-modality imaging. Each technology’s unique capabilities address specific diagnostic challenges in vulnerable plaque identification, supporting tailored interventional strategies based on individualized risk assessment. Image reproduced with permission from [43].