Optimization of Coronary Bifurcation Intervention Using Intravascular Imaging.

Purpose of Review: Coronary bifurcation lesions require complex interventions and are associated with higher complication rates. Compared to angiography alone, intravascular imaging with intravascular ultrasound (IVUS) and optical coherence tomography (OCT) allows better planning and optimization of bifurcation lesion interventions leading to improved results and long-term success. In this review, we aim to analyze the current data on utilization of intravascular imaging for optimization of interventions in complex bifurcation lesions and its impact on clinical outcomes. Recent Findings: Evidence from meta-analyses and registries favor IVUS-guided percutaneous intervention (PCI) over angiography alone due to lower rates of cardiac death, myocardial infarction, and major adverse cardiac events. Current expert consensus supports the use of OCT to evaluate plaque characteristics and vessel anatomy. Both IVUS and OCT facilitate intervention planning by identifying high-risk lesions based on plaque characteristics and functional significance, improving stent sizing through more accurately measured vessel diameter and lesion length, and optimizing stent deployment by detecting stent underexpansion and malapposition. Summary: Intravascular imaging in bifurcation lesions enhances planning, executing, and optimizing interventions, thereby contributing to improved clinical outcomes. Use of both IVUS and OCT should be considered in cases with complex anatomy such as bifurcations. With the advancement in technology such as high-resolution IVUS and 3D reconstruction for OCT, these modalities will likely have an increased role in bifurcation lesion interventions. Larger randomized studies, however, are needed to further define the role of intravascular imaging in bifurcation intervention. [ABSTRACT FROM AUTHOR]