Abstract
Intravascular ultrasound (IVUS), comprising a mechanically scanned ultrasound transducer, or a solid-state array, placed near the tip of a catheter, is now well established as a useful imaging modality in diagnosis of cardiovascular disease and for assessment of therapy. More recently, the potential for the same underlying technology to address not only diagnosis, but also therapy, has been recognized. This promotes the desirable concept of being able to perform therapy immediately after a diagnosis is made and under image guidance. Frequently, this therapy involves the use of ultrasound beams in combination with contrast microbubbles to provide enhanced local drug delivery. In addition to the therapeutic uses of microbubbles, this chapter will also address the imaging qualities facilitated by using microbubbles in the context of IVUS. When these concepts are brought together, we can assess each of anatomic structure in very fine detail, functional performance (e.g., blood flow) and the molecular signature of disease. Using relatively modest enhancements to current designs, it is possible to perform a comprehensive diagnosis and follow this immediately with image-guided therapy. It is also possible to incorporate a method to assess completion of therapy/drug delivery. A number of technical considerations, discussed in this chapter, enable this vision. Firstly, achieving therapeutic levels of ultrasound, or at least levels at which drug delivery is achieved, is feasible with appropriate device design choice. Secondly, when performing a therapeutic procedure, it is preferable to have simultaneous in time and space image guidance. Thirdly, it is attractive to have a multi-function catheter to provide each of imaging, therapy/drug delivery, and verification of delivery. Although no fully integrated diagnostic, therapy, verification catheter has been tested in vivo, this appears to be within reach in the near future.
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Acknowledgements
The author is grateful for valuable contributions made by current and former members of his research group (Adam J. Dixon, Ph.D., Joseph P. Kilroy, Ph.D., Ali H. Dhanaliwala, Ph.D., Shiying Wang, Ph.D., Linsey C. Phillips, Ph.D., and Johnny L Chen, B.S) and current and former University of Virginia colleagues: M. Ragosta, M.D., Alexander L. Klibanov, Ph.D., and Brian R. Wamhoff, Ph.D. The research program has been supported by NIH, University of Virginia Coulter Partnership, and the Virginia Commonwealth Health Research Board. Opinions expressed are those of the author and do not necessarily represent official views of sources of funding.
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Hossack, J.A. (2020). Therapeutic IVUS and Contrast Imaging. In: Zhou, Q., Chen, Z. (eds) Multimodality Imaging. Springer, Singapore. https://doi.org/10.1007/978-981-10-6307-7_10
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