Expert perspectives on the intravascular imaging guidance of PCI, diagnosis and treatment - Beyond the Guidelines: Insights from the Cardiovascular Research Technologies 2025 meeting.

Advancements in percutaneous coronary intervention (PCI) technology and post-PCI patient management have led to improvements in clinical outcomes in coronary artery disease patients. At the forefront of these advancements is intravascular imaging - reduced risks of death, myocardial infarction, repeat revascularization, and stent thrombosis have been demonstrated with intravascular imaging-guided PCI compared with angiography guidance alone. The latest 2024 European Society of Cardiology chronic coronary syndrome guidelines and the 2025 American College of Cardiology/American Heart Association acute coronary syndrome guidelines provide a Class I recommendation for use of intravascular imaging in complex PCI. At the recently concluded Cardiovascular Research Technologies 2025 Meeting, a dedicated session titled "Beyond the Guidelines - Intravascular Imaging Guidance of PCI, Diagnosis and Treatment" was conducted to address gaps in the existing guidelines. This review summarizes the scenarios not covered by the current guidelines, key takeaways from the discussion by the expert panel, and the audience's perspective on critical questions needed for future guideline developments.