In the present issue of Open Heart, Gudmundsdottir and colleagues compare two intracoronary imaging modalities, intravascular ultrasound (IVUS) and FD-optical coherence tomography (FD-OCT), in patients undergoing complex percutaneous coronary intervention (PCI) with rotablation for calcific coronary lesions. In particular, this study sought to detect incomplete stent apposition (ISA) using these different imaging modalities. ISA may play a role in the risk of target vessel failure, for example, stent thrombosis.1

Intracoronary imaging has become widely available with the advent of IVUS in the early 1990s.2 IVUS-derived images with an axial resolution down to 150 µm have given novel insights into the clinical evolution of coronary artery disease and plaque composition.3 This technology was rapidly embraced by the interventional cardiology community, mainly to assess coronary lesions of intermediate significance in larger coronary arteries, to size the stent diameter or to monitor optimal stent deployment and exclude coronary dissections post-stenting.2 While this new intracoronary imaging fuelled enthusiasm, to date, limited data exist to demonstrate that IVUS-guided PCI translates into a superior clinical outcome with respect to incomplete stent apposition (table 1). However, a large observational analysis comparing IVUS-guided against angiography-guided PCI suggested that IVUS guidance was associated with a reduction in stent thrombosis, myocardial infarction and major adverse cardiac events within …