title: Intracoronary imaging of coronary atherosclerosis: validation for diagnosis, prognosis and treatment.
abstract: While coronary atherosclerosis is a leading cause of mortality, evaluation of coronary lesions was previously limited to either indirect angiographic assessment of the lumen silhouette or post mortem investigations. Intracoronary (IC) imaging modalities have been developed that allow for visualization and characterization of coronary atheroma in living patients. Used alone or in combination, these modalities have enhanced our understanding of pathobiological mechanisms of atherosclerosis, identified factors responsible for disease progression, and documented the ability of various medications to reverse the processes of plaque growth and destabilization. These methodologies have established a link between in vivo plaque characteristics and subsequent coronary events, thereby improving individual risk stratification, paving the way for risk-tailored systemic therapies and raising the option for pre-emptive interventions. Moreover, IC imaging is increasingly used during coronary interventions to support therapeutic decision-making in angiographically inconclusive disease, guide and optimize procedural results in selected lesion and patient subsets, and unravel mechanisms underlying stent failure. This review aims to summarize current evidence regarding the role of IC imaging for diagnosis and risk stratification of coronary atherosclerosis, and to describe its clinical role for guiding percutaneous coronary interventions. Future perspectives for in-depth plaque characterization using novel techniques and multimodality imaging approaches are also discussed.
authors.affiliation: Department of Cardiology, Bern University Hospital, Bern 3010, Switzerland.
authors.forename: Konstantinos C
authors.initials: KC
authors.lastname: Koskinas
authors.affiliation: Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Giovanni J
authors.initials: GJ
authors.lastname: Ughi
authors.affiliation: Department of Cardiology, Bern University Hospital, Bern 3010, Switzerland.
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
authors.affiliation: Department of Pathology, Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA Harvard-Massachusetts Institute of Technology Health Sciences and Technology, Cambridge, MA, USA.
authors.forename: Guillermo J
authors.initials: GJ
authors.lastname: Tearney
authors.affiliation: Department of Cardiology, Bern University Hospital, Bern 3010, Switzerland lorenz.raeber@insel.ch.
authors.forename: Lorenz
authors.initials: L
authors.lastname: Räber
mesh_terms: D057791:Cardiac Imaging Techniques / Q000379:methods / Q000639:trends; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000628:therapy; D003937:Diagnosis, Differential; D005544:Forecasting; D006801:Humans; D064847:Multimodal Imaging / Q000379:methods / Q000639:trends; D062645:Percutaneous Coronary Intervention / Q000379:methods; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging; D011379:Prognosis; D011475:Prosthesis Failure; D015203:Reproducibility of Results; D015607:Stents; D041623:Tomography, Optical Coherence / Q000379:methods / Q000639:trends; D018084:Ultrasonography, Interventional / Q000379:methods / Q000639:trends
keywords: Atherosclerosis; Coronary interventions; Intracoronary imaging; Vulnerable plaque