Intracoronary Imaging for Assessing the Risk of Coronary Microvascular Obstruction

Coronary microvascular obstruction (CMVO) is a frequent occurrence after percutaneous coronary intervention (PCI), and is associated with larger myocardial infarct size and worse clinical outcome. An accurate detection of high-risk lesions for CMVO is of great importance as preventive strategies, such as the use of distal protection devices, may be able to reduce its frequency. The present chapter will focus on the role of different intracoronary imaging modalities, including intravascular ultrasound (IVUS), optical coherence tomography (OCT), angioscopy, and near-infrared spectroscopy (NIRS) for prediction of CMVO. Data available from the current literature and extensively discussed in these chapter clearly suggest that an accurate detection of coronary lesions at high-risk for the occurrence of CMVO is possible with the currently available invasive imaging techniques, particularly with IVUS and OCT. These data should guide interventional cardiologists in choosing the most appropriate treatment strategy during PCI in order to reduce the occurrence of CMVO, with the final goal of improving patient short- and long-term clinical outcome.