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Guidance for Using Intracoronary Diagnostic Tools

Guidance for Using Intracoronary Diagnostic Tools

As technology has advanced, intracoronary physiology assessments and imaging are increasingly being used in the management of patients with severe coronary stenosis. This shift in diagnostic use has been necessitated because of limitations when interpreting coronary angiography, which has been the traditional method for determining the severity of coronary stenosis. “The diagnostic effectiveness of coronary angiography is limited by inter-observer variability, even among the most experienced angiographers,” says Lloyd W. Klein, MD, FSCAI. Fortunately, several additional adjunctive techniques have emerged to further assist clinicians who care for these patients. In recent years, three diagnostic procedures have emerged that can improve decisions for coronary revascularization, guide the performance of PCI, and optimize procedural outcomes. These procedures include: 1) fractional flow reserve (FFR), 2) intravascular ultrasound (IVUS), and 3) optical coherence tomography (OCT). FFR is used to determine the functional significance of a coronary stenosis. IVUS offers excellent visualization of the intraluminal and transmural coronary anatomy. OCT was approved for use in the United States in 2010. It further improves vascular visualization to help determine causes of blood clots and blockages of critical blood flow.   “There is now persuasive evidence regarding intra-coronary diagnostic lesion assessments using these adjunctive diagnostic procedures,” adds Dr. Klein. “However, research suggests that these techniques are underutilized in contemporary practice.” Consensus Recommendations In 2011, the American College of Cardiology, American Heart Association, and Society for Cardiovascular Angiography and Interventions (SCAI) released joint guidelines for using PCI, but a deeper analysis of the available literature was necessary to guide clinicians when using FFR, IVUS, and OCT. In 2013, SCAI issued a consensus statement that reviewed recent studies on these diagnostic...
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