Role of Intravascular Imaging in Percutaneous Coronary Interventions for Left Main Coronary Bifurcation Lesions

The number of interventions for left main coronary bifurcation lesions in the Russian Federation increase annually. Such lesions are among the most challenging cases for endovascular treatment due to a high risk of cardiovascular complications. They are difficult to assess by angiography, and surgeons frequently encounter difficulties during interventions. To avoid complications and improve long-term outcomes, it is crucial to accurately determine the appropriateness of an intervention, assess characteristics of the lesion, and choose the most effective treatment strategy, and intravascular imaging methods, such as fractional flow reserve measurement, intravascular ultrasonography, and optical coherence tomography, can assist in doing so. Recent research demonstrates the effectiveness of these imaging methods at each stage of surgery; however, several contentious and debatable issues that warrant attention and further investigation remain. This article reviews the latest research regarding the use of intravascular imaging to optimize percutaneous coronary interventions in patients with left main coronary bifurcation lesions, as well as to highlight unresolved issues that require further exploration.