When Images Speak, Listen

   This editorial contextualizes the RENOVATE-COMPLEX-PCI trial, which demonstrated improved outcomes in complex percutaneous coronary intervention (PCI) using intravascular imaging guidance compared to angiography alone. The trial enrolled patients with complex coronary disease and showed a 4.6 percentage point reduction in the composite endpoint of cardiac death, target-vessel MI, and revascularization. Imaging techniques included intravascular ultrasonography and optical coherence tomography (OCT). Despite modest stent optimization rates (45.4% imaging vs. 58.9% angiography), outcomes favored imaging-guided PCI. The editorial highlights imaging’s role in vessel sizing, stent expansion, and complication detection. Limitations include single-country enrollment and low revascularization rates in controls. It argues that imaging-guided PCI should be routinely considered in complex cases and discusses the importance of early lesion visualization in optimizing procedural success.

   This editorial contextualizes the RENOVATE-COMPLEX-PCI trial, which demonstrated improved outcomes in complex percutaneous coronary intervention (PCI) using intravascular imaging guidance compared to angiography alone. The trial enrolled patients with complex coronary disease and showed a 4.6 percentage point reduction in the composite endpoint of cardiac death, target-vessel MI, and revascularization. Imaging techniques included intravascular ultrasonography and optical coherence tomography (OCT). Despite modest stent optimization rates (45.4% imaging vs. 58.9% angiography), outcomes favored imaging-guided PCI. The editorial highlights imaging’s role in vessel sizing, stent expansion, and complication detection. Limitations include single-country enrollment and low revascularization rates in controls. It argues that imaging-guided PCI should be routinely considered in complex cases and discusses the importance of early lesion visualization in optimizing procedural success.