Intravascular imaging has revolutionized the assessment and management of coronary artery disease, providing unparalleled insights into plaque morphology, lesion severity, and percutaneous coronary intervention (PCI) optimization. This comprehensive review explores the current landscape of intravascular imaging, detailing the principles and clinical utility of intravascular ultrasound (IVUS) and optical coherence tomography (OCT). We discuss the role of these technologies in various clinical scenarios, ranging from stable coronary artery disease to acute coronary syndromes, emphasizing their ability to refine diagnostic accuracy and therapeutic decision-making. A key focus is placed on their application in identifying vulnerable plaques, a critical step in preventing adverse cardiovascular events. Furthermore, we highlight the role of intravascular imaging in guiding PCI, improving stent deployment, and reducing procedural complications. Finally, we explore emerging imaging modalities and technological advancements poised to further enhance coronary assessment, including hybrid imaging techniques. In addition to established modalities, this review examines emerging imaging technologies and the growing integration of artificial intelligence (AI) and hybrid imaging systems, which hold promise for automated plaque characterization, improved reproducibility, and enhanced decision support during PCI. By summarizing the latest evidence and future directions, this review aims to provide a comprehensive reference for clinicians and researchers seeking to optimize the use of intravascular imaging in contemporary cardiovascular practice.

Background: Leadless pacemakers (LPMs) have been shown to reduce complications compared with conventional transvenous pacing. Transfemoral venous access (FA) is the standard implantation approach; however, the transjugular approach (JA) has recently emerged as an alternative strategy, but comparative evidence remains limited. Therefore, we perform a systematic review and meta‐analysis comparing JA and FA for LPMs implantation in terms of electrical performance, procedural efficiency, and complications. Methods: All studies comparing JA and FA for LPMs were systematically identified. Pooled analyses were performed for pacing threshold, sensed R‐wave amplitude, impedance, total procedural time, fluoroscopy duration, and procedural complications. Results: Three observational studies were included. No significant differences were observed between FA and JA in mean pacing threshold (MD 0.05 ms; 95% CI −0.03 to 0.12), mean sensed R‐wave amplitude (MD 0.31 mV; 95% CI −0.51 to 1.14), or impedance (MD 45.79 Ω; 95% CI −27.03 to 118.61). Total procedural time was comparable between approaches (MD −0.44 min; 95% CI −8.47 to 7.60). JA was associated with a significant reduction in fluoroscopy time compared with FA (MD 2.73 min; 95% CI 0.66 to 4.81). JA also significantly reduced overall procedural complications (1.8% vs. 15%; OR 0.12, 95% CI 0.04 to 0.39) and wound care–related adverse events (0% vs. 14%; OR 0.07, 95% CI 0.01 to 0.36). No differences were observed in device dislodgement, pericardial effusion, or emergent device removal. Conclusions: JA provides comparable electrical performance to FA while reducing fluoroscopy exposure and access‐related complications, supporting its use as a safe alternative for LPMs implantation.

Coronary bifurcation lesions are considered among the most challenging lesions to treat with percutaneous coronary intervention (PCI), particularly in cases of extensively diseased branches. In the event of failure of a provisional (one-stent) approach, many two-stent bifurcation techniques can be performed for the treatment of coronary bifurcation lesions. Two techniques (culotte and T/TAP) are suggested by the European Bifurcation Club, but a reverse crush is performed by some operators. This study aims to retrospectively compare these two different approaches (EBC-recommended techniques vs. reverse crush).