Invasive Imaging Assessment of Coronary Artery Diseases

This chapter explores invasive imaging techniques for assessing coronary artery disease (CAD), emphasizing their clinical applications and comparative advantages. While invasive coronary angiography (ICA) remains the gold standard for anatomical visualization, its limitations in evaluating plaque composition and hemodynamics are addressed by intravascular ultrasound (IVUS) and optical coherence tomography (OCT), which enhance resolution and tissue characterization. Fractional flow reserve (FFR) is highlighted for its role in physiological assessment, guiding revascularization decisions through ischemia detection. Emerging technologies like instantaneous wave-free ratio (iFR) and quantitative flow ratio (QFR) offer adenosine-free alternatives, improving procedural efficiency. Clinical trials demonstrate the efficacy of these tools in optimizing treatment strategies, reducing unnecessary interventions, and enhancing outcomes in complex lesions, multivessel disease, and acute coronary syndromes. The integration of anatomical and functional assessments underscores a paradigm shift toward precision medicine in CAD management.