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REV I EW T O PIC O F T HE WEEK
Clinical Utility of Intravascular Imaging and Physiology in Coronary Artery Disease
Gary S. Mintz, MD
More than 2 decades have passed since Drs. Nico Pijls and Bernard DeBruyne intro- duced fractional ﬂow reserve (FFR) as a method of assessing coronary stenosis severity and since Dr. Paul Yock invented grayscale intravascular ultrasound (IVUS) that spawned second-generation intravascular imaging techniques such as: 1) IVUS radiofrequency tissue characterization, including vir- tual histology (VH)-IVUS, integrated backscatter IVUS, and iMap; 2) optical coherence tomography (OCT), the light analogue of IVUS; and 3) near- infrared spectroscopy that detects lipid within the vessel wall and that has recently been combined with grayscale IVUS in a single catheter as the ﬁrst combined imaging device. These tools have moved beyond the research setting. They are useful for answering questions that occur during daily practice including: Is this stenosis signiﬁcant? Where is the culprit lesion? Is this a vulnerable plaque? What is the likelihood of distal embolization or periprocedural myocardial infarction (MI) during stent implantation? How do I optimize acute stent results? Why did thrombosis or restenosis occur in this stent?
The subspecialty of interventional cardiology is data driven. Although correlations with histopa- thology are important, the ultimate beneﬁt will be determined if these techniques improve clinical diagnosis, treatment, outcomes, and whether pa- tients beneﬁt, irrespective of technical or histopath- ological accuracy.
IS T H IS ST ENO S IS SIG N I F I C AN T?
Three randomized trials (DEFER [Deferral Versus Performance of PTCA in Patients Without Docu- mented Ischemia], FAME [Fractional Flow Reserve Versus Angiography for Multivessel Evaluation]-I, and FAME-II) established FFR (the ratio of distal to proximal pressure at maximum hyperemia) as the...
From the Cardiovascular Research Foundation, New York, New York. Dr. Mintz has received speakers’ bureau and fellowship support from Boston Scientiﬁc; and is a consultant to and receives research support from Volcano Corporation and InfraReDx, Inc.
Manuscript received September 30, 2013; revised manuscript received January 2, 2014, accepted January 14, 2014.
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