Chronic Coronary Artery Lesions: Advanced Diagnostic Modalities and Therapeutic Strategies with Emphasis on Intravascular Ultrasound and Optical Coherence Tomography

Abstract

Chronic coronary artery lesions represent a complex and progressive manifestation of atherosclerotic disease, often leading to significant morbidity and mortality due to myocardial ischemia and subsequent adverse cardiovascular events. The accurate diagnosis and characterization of these lesions are paramount in guiding optimal therapeutic interventions and improving long-term prognostic outcomes. In contemporary interventional cardiology, intravascular ultrasound (IVUS) and optical coherence tomography (OCT) have emerged as indispensable imaging modalities, offering high-resolution, cross-sectional visualization of coronary artery architecture, plaque composition, and vessel dimensions. These advanced techniques facilitate precise lesion assessment, enabling tailored revascularization strategies, including percutaneous coronary intervention (PCI) with stent optimization. This article comprehensively reviews the pathophysiology of chronic coronary lesions, current evidence-based treatment approaches, and the prognostic implications of various therapeutic modalities. Furthermore, it highlights the pivotal role of IVUS and OCT in enhancing diagnostic accuracy, procedural success, and long-term vessel patency, thereby refining clinical decision-making in the management of chronic coronary artery disease.