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Dr Giulio Guagliumi, Italy 05 March 2019

Imaging guidance has more clinical evidence in complex lesion/patient cohorts.
It is not imaging per se but its correct interpretation, measurements and consequent action that makes a difference.
Imaging is not FFR, does not give a black and white answer and we are still trying to find a practical algorithm to apply.
Each Cath lab should develop expertise with at least one of these two technologies and that a busy lab should know how to implement both imaging methods in more straightforward lesions.
OCT in contrast to IVUS can often assess calcium thickness.
Patients with LM lesions should be considered for imaging-guided intervention by IVUS or OCT (in nonostial LM lesions), due to particular challenges in angiographic evaluation and procedural complexity and because of the clinical sequelae of a suboptimal result in this context.
OCT for guidance of PCI is more user-friendly as the interpretation is simpler and automatic analyses are available immediately.
Patients at high risk of developing contrast-induced AKI can benefit from IVUS-guided PCI due to potential for lower volume of contrast.

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