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Cardiology
Intravascular Ultrasound
Built from Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
What’s inside
8 sections · 113 slides
Overview
- Scope of this presentation
- Limitations of coronary angiography
- Development of intravascular ultrasound
- What IVUS adds to the catheterisation laboratory
The normal and diseased vessel
- Elastic and muscular arteries
- Layers of the arterial wall
- Tunica intima
- Tunica media
- Tunica adventitia
- Three-layered appearance of the normal vessel
- Atherosclerosis as the basis of coronary disease
- Compensatory enlargement and the 40% threshold
- Consequences of plaque rupture
- Coronary dissection
- Spontaneous coronary artery dissection
- Distinguishing false from true lumen
- Angiographic classification of SCAD
- Intramural haematoma in spontaneous coronary dissection
- Iatrogenic coronary dissection
- Coronary artery aneurysm
- Coronary vasculitis
- In-stent restenosis
- In-stent restenosis with multiple stent layers
- Stent thrombosis
- Timing of vein graft failure
- Vein graft appearance on IVUS
- Plaque types on IVUS
- Attenuated plaque
- Thrombus and plaque rupture on IVUS
- Ruptured plaque and residual fibrous cap
- Calcified deposits on IVUS
- Depth and morphology of coronary calcium
- Patterns of coronary calcification
- Myocardial bridging
Indications and evidence
- Guideline recommendations for intracoronary imaging
- Underuse of intracoronary imaging
- Registry evidence in acute myocardial infarction
- Unprotected left main stenting: MAIN-COMPARE
- Bifurcation lesions: the COBIS registry
- HOME DES IVUS
- Long lesions randomised trial
- Chronic total occlusion
- Randomised data in chronic total occlusion
- The ULTIMATE trial
- How ULTIMATE achieved its result
- Observational and pooled evidence
- Where the evidence currently stands
Equipment and physics
- Basic principles of IVUS imaging
- Frequency, resolution and penetration
- Two catheter architectures
- Solid-state phased array systems
- Mechanically rotating single-transducer systems
- Guidewire position and its consequences
- Gain and time gain compensation
Performing and reading the study
- Preparation before an IVUS run
- Catheter insertion and advancement
- Pullback and image acquisition
- Safety of intracoronary ultrasound
- Image orientation
- Blood, lumen and tissue interfaces
- Reference lines for IVUS measurement
- Adjacent structures seen on pullback
- Principles of IVUS measurement
- Recommended lumen measurements
- EEM cross-sectional area
- Atheroma measurement and its limitation
- Directions of vessel remodelling
- Diagnostic applications of IVUS
- Detecting calcium before intervention
- IVUS criteria favouring calcium modification
- Calcified nodules
- Assessment of previously placed stents
- Vulnerable and ruptured plaque on IVUS
- True aneurysm versus pseudoaneurysm
Interventional applications
- IVUS-guided PCI workflow
- Baseline lesion assessment before PCI
- Choosing stent diameter
- Determining stent length
- Post-deployment assessment
- Stent malapposition
- Minimal stent area and its targets
- Recommended stent measurements
- IVUS criteria for optimal stent deployment
- Grading post-intervention dissection
- Contrast reduction with IVUS guidance
Artifacts and limitations
- Motion artifact
- Non-uniform rotational distortion
- Ring-down artifact
- Guidewire artifact
- Other artifacts
IVUS, OCT and virtual histology
- IVUS compared with optical coherence tomography
- Evidence comparing OCT and IVUS guidance
- Virtual histology plaque map
- Status of virtual histology IVUS
- Conclusions
- Future directions
- Key numbers to remember
- References
- References
- References
- References
- References
- References
- References
- Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
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