Intracoronary imaging to guide percutaneous coronary intervention: Clinical implications Giancarla Scalone, Giampaolo Niccoli, Omar Gomez Monterrosas,

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Intracoronary imaging to guide percutaneous coronary intervention: Clinical implications Giancarla Scalone, Giampaolo Niccoli, Omar Gomez Monterrosas, Pierfrancesco Grossi, Alessandro Aimi, Luca Mariani, Luca Di Vito, Kayode Kuku, Filippo Crea, Hector M. Garcia-Garcia International Journal of Cardiology Volume 274, Pages 394-401 (January 2019) DOI: 10.1016/j.ijcard.2018.09.017 Copyright © 2018 Elsevier B.V. Terms and Conditions

Fig. 1 Use of intra-coronary imaging (ICI) in routine clinical practice. ICI is employed in different clinical setting: assessment of clinical and imaging outcomes of the percutaneous coronary intervention (PCI); guiding PCI before and after stent implantation; identification of mechanisms of stent failure (SF). Before stent implantation, ICI can characterize coronary plaque, identify proper stent diameter and length, and features of calcifications. After stent implantation, ICI can detect correctable abnormalities associated with SF: malapposition, edge dissection, under-expansion, geographic plaque miss, tissue prolapse; optimize the bioresorbable vascular scaffold (BVS) implantation. ICI can identify the mechanisms of SF, clarifying the causes of stent thrombosis (ST) (malapposition, edge dissection, neoatherosclerotic, uncovered struts, stent under-expansion) and of in-stent re-stenosis (ISR) (intimal hyperplasia, under-expansion, stent fracture and neoatherosclerosis). International Journal of Cardiology 2019 274, 394-401DOI: (10.1016/j.ijcard.2018.09.017) Copyright © 2018 Elsevier B.V. Terms and Conditions

Fig. 2 Features visualized by intravascular coronary imaging. Panel A and A’: example of calcifications (yellow arrowheads) at intravascular ultrasound (IVUS) and optical coherence tomography (OCT), respectively. Panel B and B’: example of incomplete stent apposition (ISA) at IVUS and OCT, respectively. Panel C and C’: example of stent edge dissection (flap indicated by yellow arrowhead) at IVUS and OCT, respectively. IVUS and OCT images are taken from different coronaries of different patients. International Journal of Cardiology 2019 274, 394-401DOI: (10.1016/j.ijcard.2018.09.017) Copyright © 2018 Elsevier B.V. Terms and Conditions

Fig. 3 Stent under-expansion (SU) at OCT and IVUS caused by negative remodelling. Panel A and A’: distal reference lumen area (RLA) at OCT and IVUS, respectively; Panel B and B’: minimal stent area (MSA) at OCT and IVUS, respectively; Panel C and C’: proximal RLA at OCT and IVUS, respectively; SU is calculated as MSA divided by the average of proximal and distal RLA. International Journal of Cardiology 2019 274, 394-401DOI: (10.1016/j.ijcard.2018.09.017) Copyright © 2018 Elsevier B.V. Terms and Conditions

Fig. 5 The leading causes of stent thrombosis visualized by intra-coronary imaging. Panel A and A’: example of malapposition at IVUS and at OCT (respectively). Panel B ad B’: example of neo-atherosclerosis at IVUS and OCT, respectively. Panel C and C’: example of uncovered struts (red arrowheads) at IVUS and OCT, respectively. International Journal of Cardiology 2019 274, 394-401DOI: (10.1016/j.ijcard.2018.09.017) Copyright © 2018 Elsevier B.V. Terms and Conditions