We now have enough evidence to support systematic OCT in daily PCI practice: pros and cons

Introduction

Intravascular coronary imaging has the potential to address the limitations of angiography in guiding percutaneous coronary intervention (PCI) procedures. In particular, optical coherence tomography (OCT) can offer valuable insights into vessel and plaque characteristics. When used after PCI, OCT can also give important information on stent implantation, highlighting eventual needs for PCI optimisation and, therefore, contributing to improved PCI outcomes. However, OCT remains underused because of concerns regarding procedural time, costs and safety. In addition, current evidence on the routine use of OCT is controversial and, when intravascular imaging (IVI) is indicated, intravascular ultrasound (IVUS) might be preferred based on anatomical or procedural considerations. Whether accruing evidence will foster OCT as a standard tool for guiding and optimising PCI is an area of uncertainty.

Pros

Although PCI is mostly guided by angiography, its use has well-established limitations in assessing lesion severity, plaque morphology and atherosclerosis burden, which are crucial in pre-PCI planning1. It is also limited in detecting stent underexpansion, malappositon, edge dissection, and...