Optical coherence tomography (OCT), an established intravascular imaging technique, enables rapid acquisition of high-resolution images during invasive coronary procedures to assist physician decision-making. OCT has utility in identifying plaque/lesion morphology (e.g., thrombus, degree of calcification, and presence of lipid) and vessel geometry (lesion length and vessel diameter) and in guiding stent optimisation through identification of malapposition and underexpansion. The use of OCT guidance during percutaneous coronary interventions (PCI) has demonstrated improved procedural and clinical outcomes in longitudinal registries, although randomised controlled trial data remain pending. Despite growing data and guideline endorsement to support OCT guidance during PCI, its use in different countries is not well established. This article is based on an advisory panel meeting that included experts from Southeast Asia (SEA) and is aimed at understanding the current clinical utility of intracoronary imaging and OCT, assessing the barriers and enablers of imaging and OCT adoption, and mapping a path for the future of intravascular imaging in SEA. This is the first Southeast Asian consensus that provides insights into the use of OCT from a clinician's point of view.
Coronary calcified nodules are an uncommon but important substrate for acute coronary syndromes, stent underexpansion, and recurrent target lesion revascularization. This consensus integrates pathologic, imaging, prognostic, and interventional evidence to guide practical decision-making. Intravascular imaging is essential for diagnosis, mechanism definition, and procedural optimization. Optical coherence tomography provides superior assessment of cap disruption and thrombus, whereas intravascular ultrasound remains valuable when contrast exposure or lesion crossing limits optical coherence tomography. Treatment should be tailored to lesion crossability, calcium distribution, and the need for mechanical scaffolding. No calcium-modification device or drug-eluting stent vs drug-coated balloon strategy has demonstrated consistent superiority. The proposed type IIa/IIb framework is hypothesis-generating and requires prospective validation. Calcified nodule-related target lesion failure should be managed by correcting the dominant mechanical mechanism before antiproliferative therapy. These recommendations emphasize individualized, imaging-guided percutaneous coronary intervention and identify priorities for prospective comparative research.