Despite the great innovations of non-invasive coronary imaging, coronary angiography still remains the gold standard for the assessment of coronary artery disease (CAD), even if with several limitations. In fact visual assessment of coronary stenosis is convenient and rapid, but often associated with large inter and intra-observer variability, above all in the setting of unstable CAD with complex lesions.
Coronary intravascular ultrasound (IVUS) allows accurate tomographic assessment of the coronary lumen and wall. IVUS has several diagnostic applications and is useful for choosing the most appropriate interventional strategy as well as for optimizing percutaneous coronary interventions (PCI) results. The present review focuses on: (1) the role of IVUS to guide therapeutic strategies in complex lesions requiring PCI, (2) IVUS capacity to interrogate borderline coronary stenoses, (3) new perspectives and recent patents for the future of IVUS technology.