Factors Contributing to Low Utilization of Intracoronary Imaging

This white paper addresses the barriers to the utilization of intracoronary imaging (ICI) in clinical practice, particularly in the context of percutaneous coronary intervention (PCI). It identifies a core problem where interventional cardiologists (ICs) often have a false sense of success with PCI procedures due to a lack of long-term follow-up on complications. The paper outlines how the absence of intravascular imaging (IVI) systems prevents benchmarking and contributes to overconfidence in angiography-guided PCI. It discusses the insufficient familiarity among clinicians with evidence supporting IVI benefits, despite existing guidelines from the European Society of Cardiology (ESC) and American College of Cardiology (ACC) recommending IVI use in complex cases. Additionally, the paper highlights educational structures that may hinder the acceptance of IVI, including debate-style sessions that misrepresent imaging as optional and limited exposure for trainees. The emotional and cognitive dissonance experienced by operators when confronting the limitations of angiography is also examined as a significant barrier to adopting IVI practices.