Role of Intracoronary Imaging and Physiology in Acute Coronary Syndrome

Recent advancements in intravascular imaging technologies have transformed our capacity to precisely identify and assess the culprit lesions responsible for acute coronary syndrome in clinical practice. Acute coronary syndrome commonly results from atherosclerotic plaque rupture, causing intracoronary thrombosis and acute myocardial ischemia, frequently presenting with chest discomfort and dyspnea. Intravascular imaging techniques, including near-infrared spectroscopy, optical coherence tomography, and intravascular ultrasound, provide more detailed insights into high-risk coronary lesions, overcoming the limitations of traditional coronary angiography. There is a growing clinical interest in the use of in vivo intravascular imaging to precisely characterize the morphology of atherosclerotic plaques, which are influenced by local hemodynamic flow. This article aims to offer a thorough examination of intravascular imaging technologies and physiological assessments, emphasizing their clinical utility in diagnosing and managing acute coronary syndrome, while also exploring their potential in shaping personalized treatment strategies to enhance patient outcomes.