Intravascular imaging (IVI) has emerged as a pivotal tool in percutaneous coronary intervention (PCI), offering superior visualization of coronary anatomy compared with conventional angiography. This literature review synthesizes the latest evidence from randomized trials and meta-analyses published since 2022, assessing the comparative efficacy of IVI modalities—including intravascular ultrasound (IVUS) and optical coherence tomography (OCT)—in complex coronary lesions. Multiple landmark trials, such as RENOVATE-COMPLEX PCI, ILUMIEN IV, OCTOBER, and OCTIVUS, demonstrated that IVI-guided PCI significantly improves procedural outcomes, stent optimization, and clinical endpoints such as target-vessel failure, myocardial infarction, and stent thrombosis. OCT was shown to be particularly beneficial in bifurcation and left main interventions, while IVUS consistently improved outcomes in long lesions and complex anatomies. Despite some trials not meeting their primary clinical endpoints, substudy findings and pooled analyses support a shift toward routine IVI use in anatomically complex cases. Consequently, updated guidelines now recommend IVI as a Class I indication in select patient populations. These findings underscore the need for broader clinical adoption and training in IVI techniques to enhance PCI outcomes.

Coral reef aorta (CRA) is defined by the presence of heavily calcified exophytic plaques that protrude into the aortic lumen. Open surgery remains the standard treatment but is associated with substantial morbidity, particularly in high-risk patients. Endovascular approaches, including intravascular lithotripsy (IVL), have emerged as less invasive alternatives. This case series aimed to evaluate the feasibility, safety, and hemodynamic impact of IVL combined with fractional flow reserve (FFR) in the treatment of calcified aortic stenoses. We present a case series of three patients with severe calcified abdominal aortic stenosis treated with IVL under FFR guidance. Pre- and post-procedural FFR measurements were used to assess lesion hemodynamic significance and treatment efficacy. All procedures were technically successful, with significant improvement in FFR values following IVL, indicating restoration of hemodynamic flow. One case was complicated by an aortic dissection, successfully managed with stent placement. In the remaining cases, IVL achieved adequate luminal gain without the need for stenting. At follow-up (up to 12 months), all patients demonstrated sustained clinical improvement and maintained vessel patency. IVL combined with FFR appears to be a feasible and effective minimally invasive approach for the management of heavily calcified aortic lesions. This strategy allows both morphological plaque modification and objective physiological assessment, potentially reducing the need for stent implantation. Larger studies are required to validate these findings.

Background: Hemoptysis is a potentially life-threatening respiratory emergency that requires prompt evaluation and management. Bronchial artery embolization (BAE) is currently regarded as the first-line treatment for massive and recurrent hemoptysis because of its high technical and clinical success rates, minimally invasive nature, and favorable safety profile. The aim of this retrospective study was to evaluate the technical and clinical outcomes of bronchial artery embolization in patients presenting with hemoptysis, including procedure-related complications and recurrence during follow-up. Methods: A single-center, retrospective, observational study was conducted. Thirty-five consecutive adult patients (37 procedures) who underwent BAE for hemoptysis between January 2018 and April 2026 were identified. Immediate outcomes were analyzed in all patients, whereas follow-up outcomes were analyzed in the 30 patients (32 procedures) with available follow-up data. Clinical, imaging, procedural, and follow-up data were collected from electronic medical records and the Picture Archiving and Communication System (PACS). Technical success (per procedure) was defined as embolization of all angiographically identified target arteries with achievement of the angiographic endpoint, and clinical success (per patient) as complete cessation or significant reduction in hemoptysis within 48 h after the index BAE, sustained until discharge; persistent bleeding or rebleeding before discharge was classified as clinical failure. Recurrence of hemoptysis was assessed separately during follow-up and was defined as any new episode of hemoptysis occurring after discharge in patients with initial clinical success, regardless of severity or the need for repeat embolization. Results: Technical success was achieved in all 37 procedures (100%) and clinical success in 34/35 patients (97.1%); the remaining patient underwent successful repeat BAE during the index hospitalization. Procedure-related adverse events occurred after 2/37 procedures (5.4%) and consisted of transient chest pain due to non-target embolization of Onyx into intercostal branches (CIRSE grade 1); no major complications occurred. In the 30 patients with follow-up (median 14.6 months), recurrent hemoptysis occurred in 3 (10.0%), all within the first year, and one (3.3%) required repeat BAE. Conclusions: In this single-center retrospective series, BAE, performed predominantly with liquid embolic agents, was associated with high technical and clinical success and a low rate of minor procedure-related complications. These findings are descriptive and hypothesis-generating. Because of the retrospective design, small sample size, attrition, heterogeneous etiologies, and absence of a comparator group, no conclusions on comparative effectiveness can be drawn. Larger prospective multicenter studies are needed.