Contemporary practices using intravascular imaging guidance with IVUS or OCT to optimize percutaneous coronary intervention.

: Angiography is routinely used to perform percutaneous coronary intervention (PCI). However, angiography has many limitations that prevent accurate assessment of coronary lesions. The development and evolution of intravascular imaging have offset the limitations of angiography. Overwhelming evidence supports intravascular imaging guidance to optimize PCI results and studies have shown that it is associated with better outcomes. Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) are the most commonly used modalities and both have far greater spatial resolution compared with angiography. There are advantages and disadvantages to both IVUS and OCT, and the optimal modality will depend on patient factors and indications.: This review will summarize clinical evidence and current practices in the use of intravascular imaging in PCI. Literature review from year 2000-2019 was completed via PubMed search using keywords.: Intravascular imaging is an essential tool in PCI that has outcome implications, but it is still underutilized. Proper image acquisition, accurate interpretation, and correct decision-making are needed for patients to benefit from imaging-guided PCI. Training and education are essential in successful utilization of imaging technology. High-definition IVUS is likely to gain favor as there is improved image resolution without the use of contrast.