Clinical use of intracoronary imaging. Part 2: acute coronary syndromes, ambiguous coronary angiography findings, and guiding interventional decision-making: an expert consensus document of the European Association of Percutaneous Cardiovascular Interventions
Thomas W. Johnson1; Lorenz Räber2; Carlo Di Mario3; Christos V. Bourantas4; Haibo Jia5; Alessio Mattesini4; Nieves Gonzalo6; Jose Maria de la Torre Hernandez7; Francesco Prati8; Konstantinos C. Koskinas2; Michael Joner9; Maria D. Radu10; David Erlinge11; Evelyn Regar12; Vijay Kunadian13; Akiko Maehara14; Robert A. Byrne9; Davide Capodanno15; Takashi Akasaka16; William Wijns17; Gary S. Mintz14; Giulio Guagliumi18
1. Department of Cardiology, Bristol Heart Institute, University Hospitals Bristol NHSFT & University of Bristol, BS2 8HW, Bristol, United Kingdom; 2. Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland; 3. Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy; 4. Department of Cardiology, Barts Heart Centre, Barts Health NHS & Queen Mary University, London, United Kingdom; 5. Department of Cardiology, 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China; 6. Department of Cardiology, Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain; 7. Department of Cardiology, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain; 8. Department of Cardiology, San Giovanni Hospital, Rome, Italy & CLI Foundation Rome, Italy; 9. Deutsches Herzzentrum München, DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Technische Universität München, Munich, Germany; 10. Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; 11. Department of Cardiology, Lund University, Skane University Hospital, Lund, Sweden; 12. Department of Cardiovascular Surgery, Zürich University Hospital, Zürich, Switzerland; 13. Institute of Cellular Medicine, Newcastle University and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, United Kingdom; 14. Cardiovascular Research Foundation, Columbia University, New York, NY, USA; 15. Division of Cardiology, Cardio-Thoraco-Vascular and Transplant Department, CAST, Rodolico Hospital, AOU “Policlinico-Vittorio Emanuele”, University of Catania, Catania, Italy; 16. Wakayama Medical University, Wakayama, Japan; 17. The Lambe Institute for Translational Medicine and Curam, National University of Ireland Galway, Saolta University Healthcare Group, Galway, Ireland; 18. Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo 24127, Italy
This consensus document is the second of two reports summarizing the views of an expert panel organized by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) on the clinical use of intracoronary imaging including intravascular ultrasound (IVUS), optical coherence tomography (OCT), and near infrared spectroscopy (NIRS)-IVUS. Beyond guidance of stent selection and optimization of deployment, invasive imaging facilitates angiographic interpretation and may guide treatment in acute coronary syndrome. Intravascular imaging can provide additional important diagnostic information when confronted with angiographically ambiguous lesions and allows assessment of plaque morphology enabling identification of vulnerability characteristics. This second document focuses on useful imaging features to identify culprit and vulnerable coronary plaque, which offers the interventional cardiologist guidance on when to adopt an intracoronary imaging-guided approach to the treatment of coronary artery disease and provides an appraisal of intravascular imaging-derived metrics to define the haemodynamic significance of coronary lesions.