Angiographic and intravascular imaging assessment in percutaneous coronary intervention From classic geometric assessment to physiological assessment derived from geometric information

Coronary artery disease (CAD) is an important disease when one considers global health. An increasing incidence of CAD is common phenomenon around the world. Percutaneous coronary intervention (PCI) has evolved for decades with developments of coronary devices. In the current thesis, we investigated the applicability of angiographic and intravascular imaging assessment to the current clinical and research practice involving PCI. To date, coronary device has developed to improve its efficacy by reducing neointimal growth after the implantation. In the current era with contemporary coronary devices, the limitation of geometric assessment using conventional angiography was highlighted because of the discrepancy between geometric and physiological assessment. Angiography-derived FFR achieved to translate the geometric information to the physiological information. This technology is expected to expand the potential of angiographic assessment of patients with CAD. Intravascular imaging has been used for the guidance of PCI and the assessment of vessel response after the implantation of novel coronary devices. Detailed geometric information derived from intravascular imaging can be utilized for the computational fluid dynamics (CFD) simulation. This technology enhanced the understanding of the coronary microenvironment around the implanted device such as the relationship between wall shear stress (WSS) and neointimal growth after BRS implantation. Imaging of coronary artery is developing to provide not only geographic but also physiological information of coronary artery. Further developments of coronary imaging are expected.