Title:Novel Applications for Invasive and Non-invasive Tools in the Era of Contemporary
Percutaneous Coronary Revascularisation
Volume: 18
Issue: 1
Author(s): Mohammad Alkhalil*
Affiliation:
- Department of Cardiothoracic Services, Freeman hospital, Newcastle-upon-Tyne UK
- Department of Cardiology,
Toronto General Hospital, Toronto Canada
Keywords:
PCI, NIRs, IMR, CMR, CAD, mapping, CFR.
Abstract: Percutaneous coronary intervention (PCI) is an expanding treatment option for patients
with coronary artery disease (CAD). It is considered the default strategy for the unstable presentation
of CAD. PCI techniques have evolved over the last 4 decades with significant improvements
in stent design, an increase in functional assessment of coronary lesions, and the use of intra-vascular
imaging. Nonetheless, the morbidity and mortality related to CAD remain significant. Advances
in technology have allowed a better understanding of the nature and progression of CAD. New
tools are now available that reflect the pathophysiological changes at the level of the myocardium
and coronary atherosclerotic plaque. Certain changes within the plaque would render it more prone
to rupture leading to acute vascular events. These changes are potentially detected using novel
tools invasively, such as near infra-red spectroscopy, or non-invasively using T2 mapping cardiovascular
magnetic resonance imaging (CMR) and 18F-Sodium Fluoride positron emission tomography/
computed tomography. Similarly, changes at the level of the injured myocardium are feasibly
assessed invasively using index microcirculatory resistance or non-invasively using T1 mapping
CMR. Importantly, these changes could be detected immediately with the opportunity to tailor treatment
to those considered at high risk. Concurrently, novel therapeutic options have demonstrated
promising results in reducing future cardiovascular risks in patients with CAD. This Review article
will discuss the role of these novel tools and their applicability in employing a mechanical and
pharmacological treatment to mitigate cardiovascular risk in patients with CAD.
