In recent years, intravascular ultrasound ivus has. Quantitative coronary angiography, intravascular ultrasound, virtual histology intravascular ultrasound, intermediate coronary lesions, interventional therapy, diameter stenosis rate, plaque composition, major adverse cardiovascular events introduction intermediate coronary stenosis rrefers to coronary lesions of intermediate. In this study, we used a combined imaging strategy, intravascular ultrasound ivus and optical coherence tomography oct, in 8 patients with scad. Intravascular ultrasound menu overview test details an invasive procedure, performed along with cardiac catheterization. However, it evolved with no japanese standards for the measurement of images, the index of percutaneous coronary intervention pci procedures, and the reporting of results.
Clinical application of intravascular ultrasound in coronary artery. Request pdf intravascular ultrasound imaging guided versus coronary angiographyguided percutaneous coronary intervention. Value of intravascular ultrasound in guiding coronary. Ivus directly images the vessel inside, allowing measurement of plaque morphology. Urgent coronary angiography is indicated if scad is suspected, and the diagnosis can be confirmed by intravascular ultrasound ivus. Results of the 190 patients, 49 26% group a were found to have normal or nearly normal coronary arteries, whereas the other 141 74% group b had significant angiographic stenosis 50% luminal.
Intravascular ultrasound ivus imaging is often used in conjunction with fluoroscopy to assess coronary stent implantation and guide percutaneous coronary intervention. View the article pdf and any associated supplements and figures for a period of 48 hours. Abstractintravascular ultrasound ivus is a valuable adjunct to angiography, providing new insights in the diagnosis of and therapy for coronary disease. However, the most recent american college of radiology acr manual on contrast media. Intravascular ultrasound guidance for percutaneous coronary intervention in the current practice era eviewr intravascular ultrasound ivus is an invasive imaging modality used to visualize coronary crosssectional anatomy. Since ivus is configured to be a mandatory step of an already complex and potentially risky procedure such as lmca pci, it is desirable that its application is easy and userfriendly. Although coronary angiography continues to be the standard tool to assess the coronary artery lumen. Back then, the first comparative trials comparing intravascular ultrasound ivus versus angiography. Prognostic value of intravascular ultrasound in patients. Since ivus is configured to be a mandatory step of an already complex and potentially risky procedure such as lmca pci, it. Douglas, jr, habib samady the major utility of intravascular ultrasound ivus relates to optimizing stent deployment. Although patients with pxe often have coronary artery disease, little is known about the process and the mechanism of coronary artery disease in pxe.
Contrast angiography is still the most important imaging method used to guide therapy for coronary disease. Original article virtual histology intravascular ultrasound. Importance use of intravascular ultrasound ivus promotes better clinical outcomes for coronary intervention in complex coronary lesions. Impact of intravascular ultrasoundguided percutaneous. Intravascular ultrasound ivus is a catheterbased imaging technique that provides highresolution crosssectional images of. Intravascular ultrasound provides a unique method to study the regression or progression of atherosclerotic lesions in vivo. Intravascular ultrasound ivus allows for the evaluation of the coronary pathology to obtain information about both the extent and nature of atherosclerotic plaque. Intravascular ultrasound ivus represents the first clinical imaging technique enabling routine tomographic imaging of coronary arteries. Design, setting, and participants the impact of intravascular ultrasound guidance on outcomes of xience prime stents in long lesions ivusxpl randomized, multicenter trial was conducted in 1400 patients with long coronary lesions implanted stent. Current use of intravascular ultrasound in coronary artery. Longitudinal oct c obtained from a rapid pullback 32 s immediately after manual. A closer view find, read and cite all the research you need on researchgate. Pdf recently, most coronary interventions rely on visual assessment of the coronary lesions using angiography with all known inherent.
Ivus intravascular ultrasound lmca left main coronary artery mace major adverse cardiac events mla minimum lumen area mld minimum lumen diameter pci percutaneous coronary intervention p m plaque plus media jacc vol. Intravascular ultrasound ivus is an invasive tomographic imaging modality, providing images of coronary arteries and other blood vessels. Intravascular ultrasound an overview sciencedirect topics. Ivus shows the degree of narrowing or thickening stenosis of an artery by providing a visual image of the inside of the artery the lumen and the atheroma membranecholesterol loaded white blood. Coronary angiography remains an important modality to assess atherosclerotic coronary artery disease and to guide percutaneous coronary intervention.
Intravascular ultrasound ivus is an important adjunct during coronary angiography and has been used increasingly in clinical and research applications during the past decade. Intravascular imaging an overview sciencedirect topics. Abstract dissections after coronary angioplasty are the major cause of ischemic events following percutaneous transluminal coronary angioplasty. Percutaneous coronary intervention pci is most commonly guided by angiography alone. Apr 20, 2018 complementary to coronary angiography, intravascular ultrasound ivus provides in vivo tomographic anatomic information, enabling to evaluate from the lumen to the vessel wall. Coronary intravascular ultrasound ivus has been used worldwide in percutaneous coronary intervention pci procedures for over 20 years. Percutaneous coronary intervention pci was born with angiography, but soon, the experts showed their preoccupation with coronary luminology. Percutaneous coronary intervention pci is a mainstay for the treatment of coronary artery disease, a major cause of morbidity and mortality worldwide. Expert consensus statement on the use of fractional flow. Invasive imaging modalities, in particular intravascular ultrasound ivus and optical coherence tomography oct, have become established tools for the in vivo study of coronary atherosclerosis. Optical coherence tomography oct further improves vascular visualization.
Ivus can be used to assess vessellumen diameter, lesion length, help determine the amount of plaque buildup in a vessel and its composition, and check to ensure stents have been properly placed and fully deployed. Both ivus and oct make use of an intracoronary imaging. The progressive accumulation of plaque within the artery wall over decades is the setup for vulnerable plaque which, in turn, leads to heart attack and stenosis narrowing of the artery known as coronary artery lesions. Intravascular ultrasound ivus ivus is the generic name for any ultrasound technology that provides tomographic, 3dimensional, 360degree images from inside the lumen of a blood vessel. Table 1 displays a technical comparison of the ivus and oct imaging methods.
Ivus offers precise imaging of the vessel size, plaque morphology and the presence of dissections and guides interventional procedures including stent sizing, assessing. The proximal end of the catheter is attached to computerized ultrasound. In percutaneous coronary intervention with baremetal stents, ivus guidance reduces restenosis. Coronary angiography and intravascular ultrasound sciencedirect. The diagnosis of scad required the visualization of an.
As a result, ivus has had a pivotal role to understand pathophysiology of coronary artery disease and improve clinical outcome. Pdf is intravascular ultrasound a new standard for. Their use in clinical studies has confirmed histopathological observations that certain important plaque features, such as thin fibrous caps and large lipid cores, are associated with plaque. To assess role of virtual histology intravascular ultrasound vh ivus in characterizing plaque composition and guiding interventional therapy for patients with intermediate coronary lesions icl. Methods from 2008 to 2011, rfivus was performed in 1. The aim of the study was to classify atherosclerotic lesions using ivus according to american heart association aha recommendation. Schroeder department of internal medicine, division of cardiology, university of tuebingen, tuebingen, germany. Following the advent of grayscale ivus, several modes had been. The arteries of the heart the coronary arteries are the most frequent imaging target for ivus. Intravascular imagingintravascular ultrasound and more recently optical coherence tomographyprovide a tomographical or crosssectional image of the coronary arteries.
Ivus image interpretation coronary ivus philips healthcare. Intravascular ultrasound examinations of one coronary artery and coronary angiography were performed in 525 patients at baseline. Background it has been shown that intravascular ultrasound ivus and radiofrequency rf ivus can detect highrisk coronary plaque characteristics. Background it has been shown that intravascular ultrasound ivus and radiofrequency rfivus can detect highrisk coronary plaque characteristics. When used to evaluate the coronary arteries, ivus can show the entire artery wall and provide important information about the amount and type of plaque buildup, which can help. Current use of intravascular ultrasound in coronary artery disease ahmed hassan1,2, tomotaka dohi1 and hiroyuki daida1 1department of cardiovascular medicine, juntendo university graduate school of medicine, tokyo, japan. Intravascular ultrasound in left main coronary artery percutaneous coronary intervention. Their use in clinical studies has confirmed histopathological observations that certain important plaque features, such as thin fibrous caps and large lipid cores, are associated with plaque rupture. Effect of intravascular ultrasoundguided vs angiography.
Intravascular ultrasound findings of coronary wall morphology. Intravascular ultrasound ivus offers a new modality by which to image the vessel wall in high resolution. Therefore direct imaging of the vessel wall has become a new goal in the assessment of cad progression and prevention. Coronary artery disease intravascular ultrasound percutaneous coronary intervention. Intravascular ultrasound coronary vessel or graft during diagnostic evaluation andor therapeutic intervention including imaging supervision, interpretation and report. Fractional flow reserve ffr is used to determine the functional significance of a coronary stenosis 6. Pdf use of coronary intravascular ultrasound ivus in percutaneous coronary intervention find, read and cite all the research you need. Clinical utility and significance of intravascular. The role of intravascular ultrasound in the management of spontaneous coronary artery dissection. The study goal was to determine whether the longterm clinical outcomes with ivus guided des implantation are superior to those with angiographyguided implantation in patients with long coronary lesions. Review imaging imaging of coronary atherosclerosis. Intravascular ultrasound ivus guidance has been shown to reduce major adverse cardiovascular events mace after pci, principally by resulting in a larger postprocedure lumen than with angiographic guidance.
Request pdf on aug 1, 2010, e murat tuzcu and others published coronary intravascular ultrasound. Jan, 2016 intravascular ultrasound ivus and optical coherence tomography oct are commonly used methods, while newer spectroscopic methods are under development. We use it primarily for optimization of the interventional technique, meaning vessel sizing and stent sizing, diameter, and length, and then to determine adequacy of stent deployment, which includes lesion coverage, stent expansion and. The ivus xpl study is the largest randomized, multicenter clinical trial for ivus guided vs. Extensive intramural hematoma as the cause of failed. Intravascular ultrasound ivus has emerged as an important adjunctive modality to angiography. An integrated biomarker and imaging substudy ibis4 assessed the feasibility and the procedural and longterm safety of oct and ivus in patients with stelevation mi stemi undergoing primary pci. Intravascular ultrasound ivus, developed over the past decade, has many potential advantages in characterizing the atherosclerotic disease process. Complementary to coronary angiography, intravascular ultrasound ivus provides in vivo tomographic anatomic information, enabling to evaluate from the lumen to the vessel wall.
The primary objective was to assess the late luminal loss by quantitative coronary angiography and instent percent volume obstruction by intravascular ultrasound ivus. To continue reading this article, you must log in with your personal, hospital, or group practice subscription. Ivus showed a unique five layer appearance without acoustic shadowing along the vessel wall observed in the angiographically normal portion. Ivus is used in the coronary arteries to determine the amount of atheromatous plaque built up at any particular point in the epicardial coronary artery. Angiography depicts only a 2d silhouette of the lumen, whereas ivus allows tomographic assessment of lumen area, plaque size, distribution, and composition. Intravascular ultrasound ivus is a catheterbased imaging technology that allows physicians to visualize blood vessels from the inside out. Percutaneous coronary intervention pci, coronary artery bypass grafting cabg and medical management have been described as management strategies. The role of intravascular ultrasound in the management of. Background intravascular ultrasound ivus guidance during percutaneous coronary intervention pci offers tomographic images of the coronary vessels, allowing optimization of stent implantation at. Although coronary angiography continues to be the standard tool to assess the coronary artery lumen, angiography does not supply direct information about the plaque. Intravascular ultrasound was used to elucidate the morphology of the proximal vessel obstruction, which. Combined use of oct and ivus in spontaneous coronary. Ivus technology has been proven to be superior to coronary angiography for assessment of vessel size, plaque composition, cal. The role of precise imaging with intravascular ultrasound in.
These techniques are clinically useful to answer questions such as whether the stenosis is clinically relevant. Intravascular ultrasound versus optical coherence tomography. Intravascular ultrasound ivus uses a transducer or probe to generate sound waves and produce images of blood vessels. Back then, the first comparative trials comparing intravascular ultrasound ivus versus angiographyguided pci were published. Coronary intravascular ultrasound has been used to evaluate the placement of stents and to identify the presence of a dissection or plaque in cardiac vasculature guo et al. Intravascular ultrasound guidance for percutaneous.
Intravascular imagingintravascular ultrasound and more recently optical. The role of precise imaging with intravascular ultrasound. Intravascular ultrasoundguided percutaneous coronary. Intravascular ultrasound, optical coherence tomography. In these scenarios, intravascular imaging with either intravascular ultrasound ivus or optical coherence tomography oct can be useful. The prospect trial providing regional observations to study predictors of events in the coronary tree that examined the predictors of plaque rupture in patients with acute coronary syndrome showed that plaque burden, minimal luminal area and plaque composition as seen by ivus predicted cardiovascular events. Optical coherence tomography versus intravascular ultrasound. How and why we use intravascular ultrasound cath lab digest. Get the answers not apparent from angiography alone by using ivus in your treatment strategy. However, randomized data demonstrating the clinical usefulness of ivus are limited for lesions treated with drugeluting stents. Representative images of coronary artery calcification by oct and ivus a although a sharp lumenal border lowsignal area asterisk can be visualized by optical coherence tomography oct inset, arrows, the abluminal border of the region cannot be detected, most probably due to the presence of a heterogeneous necrotic core containing calcium, lipid, and necrotic debris.
Although it is the method used by most interventional cardiologists to assess the severity of coronary artery disease and guide treatment, coronary angiography has many known limitations, particularly the fact that it is a lumenogram depicting foreshortened, shadowgraph, planar projections of the contrastfilled lumen rather than imaging the diseased vessel itself. Intravascular ultrasound findings of coronary wall. Pdf coronary intravascular ultrasound ivus researchgate. Pdf current use of intravascular ultrasound in coronary artery. Intravascular ultrasound intravascular ultrasound ivus uses a transducer or probe to generate sound waves and produce images of blood vessels. This article requires a subscription or purchase to view the full text. Darmoch f1, alraies mc2, alkhadra y3, moussa pacha h4, pinto ds1, osborn ea1. Prognostic value of intravascular ultrasound in patients with.
Optical coherence tomography compared with intravascular. Contemporary clinical applications of coronary intravascular ultrasound michael c. Intravascular ultrasound for complex percutaneous coronary. Crosssectional images help assess presence and extent of disease, plaque geometry and morphology, guide wire position during lesion crossing, and stent position posttreatment. Jan 01, 2000 the impact of untreated coronary dissections on acute and longterm outcome after intravascular ultrasound guided ptca s. Current clinical use of intravascular ultrasound imaging. Serruys1 1interventional cardiology, thoraxcenter, erasmus mc, sgravendijkwal 230, 3015 ce rotterdam, the netherlands. The first prospective ivus study defining characteristics of mildly stenotic lesions which subsequently cause acute coronary syndromes. Current clinical use of intravascular ultrasound imaging to.
Intravascular imaging in coronary artery disease the lancet. Intravascular ultrasound imaging guided versus coronary angiographyguided percutaneous coronary intervention. Objectives the authors studied the longterm prognostic value of rfivusderived plaque characteristics in patients with coronary artery disease cad undergoing coronary angiography. The intravascular imaging techniques of optical coherence tomography oct, intravascular ultrasound ivus, and coronary angioscopy ca provide information above and beyond that provided by radiograph coronary angiography. Selective intracoronary drug infusion may be desirable for a number of reasons. We do coronary, peripheral, and structural procedures. When used to evaluate the coronary arteries, ivus can show the entire artery wall and provide important information about the amount and type of plaque buildup, which can help determine if you are at risk for heart attack.
Philips intravascular ultrasound ivus imaging offers advanced visualization that enables you to tailor your treatment for every patient. Enrolled patients n 86 with quantitative coronary angiography qca confirmed icl were classified into acute coronary syndrome acs. Intravascular ultrasound imaging formation the ivus image is the result of re. Intravascular ultrasound ivus offers excellent visualization of intraluminal and transmural coronary anatomy. Intravascular ultrasound is performed by passing an approximately 3french monorail catheter, which houses the miniaturized ultrasound probe, over a coronary guidewire in the coronary artery. Impact of intravascular ultrasoundguided percutaneous coronary intervention on longterm clinical outcomes in patients undergoing complex procedures. Intravascular ultrasound intracoronary imaging icr journal. Intravascular ultrasound guided treatment for angiographically indeterminate left main coronary artery disease a longterm followup study amirali fassa, md, kenji wagatsuma, md, stuart t. During the past three decades, since the invention of intravascular ultrasound ivus, it has become increasingly important as daily clinical applications. Objective to determine whether the longterm clinical outcomes with ivus guided drugeluting stent implantation are superior. Intravascular ultrasound and optical coherence tomography. Intravascular ultrasound to guide percutaneous coronary. Over the last 20 years ivus has evolved into an excellent adjunct to coronary angiography.
Intravascular ultrasound ivus uses a tiny ultrasound transducer mounted on the tip of a catheter to image the interior of blood vessels. Intravascular ultrasound imagingguided versus coronary. Contemporary clinical applications of coronary intravascular. Intravascular ultrasound ivus radiofrequency analyses, also known as ivus virtual histology, allow for differentiation of various plaque phenotypes and may therefore be well suited for detection of plaques that are at high risk to rupture. Intravascular ultrasound ivus is a catheterbased diagnostic procedure used to view the inside of a coronary artery, providing a realtime view. Crosssectional images help assess presence and extent of disease, plaque geometry and morphology, guide wire position during. Intravascular ultrasound ivus and optical coherence tomography are intravascular imaging modalities that create crosssectional images of the coronary artery and associated pathology, such as the presence of thrombi, with higher diagnostic accuracy than conventional angiography or noninvasive computed tomography imaging 2. During pci, ivus may be used to assess the degree of narrowing in the coronary vessels in ischaemic heart disease ihd. Methods from 2008 to 2011, rf ivus was performed in 1. Patients then underwent a followup angiogram 18 to 24 months later.
In this report, intravascular ultrasound ivus imaging was performed in a female patient with pxe seven years after the onset of skin lesion to assess the coronary wall morphology in detail. Objectives the authors studied the longterm prognostic value of rf ivus derived plaque characteristics in patients with coronary artery disease cad undergoing coronary angiography. The full text of this article is available in pdf format. There is now persuasive evidence regarding intracoronary diagnostic lesion. Intravascular ultrasound, percutaneous coronary intervention, drugeluting stents. Understanding intravascular ultrasound ivus systems daic. If you are a subscriber or member, click the login link or the subscribe link in the top menu above to access this article. Intravascular ultrasound classification of atherosclerotic.
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