Intravascular Ultrasound

Abstract

Despite being the gold standard for invasive assessment of coronary artery disease (CAD), angiography provides a limited, planar evaluation of the coronary vessels. While indispensable for assessment and treatment of CAD significant limitations exist. Lesion assessment has been shown to be unreliable with both significant intra- and inter-observer variability. The addition of digital quantitative assessment is helpful, however still only marginally improves overall reproducibility of coronary angiograms. Extensively diseased coronary arteries with positive remodeling may appear only minimally diseased or even angiographically normal, leading to false reassurance of patient and provider alike. This is readily apparent when patients who have undergone coronary CT angiograms demonstrating extensive three vessel disease are referred for catheterization and who have minimal evidence of CAD angiographically. The use of intravascular ultrasound (IVUS) allows excellent visualization of both the vessel lumen as well as the surrounding vessel wall providing a more accurate assessment of the extent of CAD. In addition measurements of the vessel size and plaque characteristics can be indispensable for guidance of stent placement. IVUS has been used for decades in clinical situations such as ambiguous lesion and vessel assessment, evaluation of left main stenosis, guidance of PCI, evaluation of restenosis and stent thrombosis and in surveillance for transplant vasculopathy. Additionally, it has been invaluable for research purposes, initially in the era of PTCA followed by use in all of the major bare metal and drug eluting stent trials, providing the framework for the currently accepted interventional practices.

Keywords

Intravascular ultrasound (IVUS) IVUS for coronary artery disease (CAD) IVUS catheter Solid state IVUS catheter Rotational IVUS catheter Proximal reference vessel Distal reference vessel Radiofrequency IVUS 

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Copyright information

© Springer-Verlag London 2015

Authors and Affiliations

  1. 1.Department of CardiologyWilliam Beaumont HospitalRoyal OakUSA

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