ABSTRACT

Atherosclerotic coronary artery disease (CAD) remains one of the leading causes of morbidity and mortality worldwide. In recent years, the emergence of intravascular imaging technologies has enabled more precise characterization of vulnerable plaques-those with a high lipid core burden and increased risk of rupture. Near-infrared spectroscopy (NIRS), when integrated with intravascular ultrasound (IVUS), constitutes an advanced diagnostic modality capable of identifying high-risk lesions even in the absence of non-ischemia inducing stenosis. This combined IVUS-NIRS platform enables real-time chemical characterization of atherosclerotic plaques through the lipid core burden index (LCBI), while simultaneously providing detailed structural assessment via IVUS. Recently adopted in interventional cardiology practices across Mexico and Latin America, this technology enhances risk stratification and supports more informed decision-making during percutaneous coronary intervention (PCI). In this article, we present an updated review of the technical fundamentals, clinical utility, and key evidence supporting the use of IVUS-NIRS in coronary artery disease, including pivotal findings from the LRP, PROSPECT II, and PREVENT trials. These studies highlight the predictive value and therapeutic potential of IVUS-NIRS in guiding PCI beyond conventional angiographic or physiological parameters. Additionally, we share the initial clinical experience in Mexico, including representative case images that illustrate the practical application of IVUS-NIRS in daily practice. This imaging modality provides an additional diagnostic layer that supports optimized lesion selection, guides intensification of lipid-lowering and antithrombotic therapy, and contributes to a more personalized, evidence-based approach in contemporary interventional cardiology.

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