Intracoronary imaging, including intravascular ultrasound (IVUS) and optical coherence tomography (OCT), has become an increasingly important tool in all stages of invasive coronary disease management, from diagnosis to lesion assessment and percutaneous coronary intervention (PCI) optimization. Despite the robust and growing evidence base supporting imaging-guided PCI, there has been a slow uptake in practice, particularly in the USA. This article aims to explore barriers to the use of intracoronary imaging during PCI and potential strategies to improve the uptake of intracoronary imaging in the catheterization laboratory.

Over the past decade, several randomized trials have supported the use of intracoronary imaging in PCI to improve outcome. However, registry data has suggested that the uptake of intracoronary imaging has been particularly slow in the USA. Important barriers to the use of intracoronary imaging include procedural time, cost, perceived risk, and lack of familiarity with imaging use and interpretation. Potential strategies to improve the uptake of intracoronary imaging in the catheterization laboratory include improving training and technical support, monthly audit on PCI imaging data, and incorporation of the prescriptive imaging workflow. Preliminary analysis shows that prescriptive image-guided workflow can reduce contrast and radiation use in procedures, and result in shorter procedure time.

Despite the numerous barriers to the use of intracoronary imaging in the catheterization laboratory, these challenges can be overcome to improve patient’s outcome after PCI.