Debate: Intravascular imaging in percutaneous revascularization procedures. For a more widespread approach

QUESTION: Clinical practice guidelines have raised the recommendation level for the use of intravascular imaging during percutaneous revascularization procedures for complex lesions to class I. Can you briefly explain the basis for this change? ANSWER: The clinical benefit of intracoronary imaging-guided revascularization has been evaluated in various clinical studies, including observational registries, randomized clinical trials, and meta-analyses.1,2 However, the publication of 3 large randomized clinical trials has formed the basis for the update of clinical practice guidelines. Firstly, the RENOVATE-COMPLEX-PCI study3 assessed the clinical impact of an intracoronary imaging-guided revascularization strategy (intravascular ultrasound [IVUS] or optical coherence tomography [OCT]) compared with angiography in complex coronary lesions. One of the strengths of this study is its inclusion criteria, which emcompass a heterogeneous yet well-represented group of complex lesions beyond the left main coronary artery, such as true bifurcations, chronic total occlusion, long coronary artery disease, multivessel angioplasty, implantation of multiple stents (more than 3), severe calcification, in-stent restenosis, and ostial lesions. intracoronary imaging-guided revascularization—74% with IVUS and 26% with OCT—was associated with a 36% reduction in the composite endpoint of death, myocardial infarction, and need for revascularization. Similarly, the OCCUPI study4 demonstrated the superiority of OCT vs angiography as a guide in...