Intra Vascular Ultra Sound (IVUS)

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  • Intravascular Ultrasound (IVUS) is a catheter-based imaging procedure that uses sound waves to view cross-sectional images of the vessel lumen and the arterial wall.

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    Intravascular Ultrasound (IVUS) is a catheter-based imaging procedure that uses sound waves toview the inside of a coronary artery. Intracoronary imaging is able to aid the interventional cardiologist in the characterisation of atherosclerotic plaque morphology, in optimising stent sizing, and in minimising the complications associated with percutaneous coronary intervention (PCI).

    The ultrasound catheter is inserted into an artery in the groin area and moved up to the heart.It creates cross-sectional images of the vessel lumen and the arterial wall, showing the degree of arterial stenosis.This information helps clinical decision-making in ambiguous angiographic lesions. IVUS has also been used to evaluate new interventional devices and for atherosclerosis progression-regression trials.

    Physicians typically use IVUS to image the lining of an artery in preparation for, during or to review the results of an angioplasty (with or without stent placement) or arthrectomy. Whilst angioplasty gives a general look at the coronary arteries, it cannot show the walls of the arteries. The 2D nature of fluoroscopic imaging provides lumen profile only and the assessment of coronary stenosis by visual estimation is subjective and prone to error. Performing PCI based on coronary angiography alone is inadequate for determining key metrics of the vessel such as dimension, extent of disease, and plaque distribution and composition.

    Intracoronary imaging has the capability of accurately measuring vessel and stenosis dimensions, assessing vessel integrity, characterising lesion morphology and guiding optimal percutaneous coronary intervention (PCI).

    The advent of intracoronary imaging has offset the limitations of angiography and has shifted the paradigm to allow a detailed, objective appreciation of disease extent and morphology, vessel diameter, stent size and deployment and healing after PCI. It has become an essential tool in complex PCI, including rotational atherectomy, in follow-up of novel drug-eluting stent platforms and understanding the pathophysiology of stent failure after PCI (e.g. following stent thrombosis or in-stent restenosis).

    The American College of Cardiology Foundation/American Heart Association/Society for Cardiac Angiography (ACC/AHA/SCAI)31 and European Society of Cardiology/European Association for Cardio-Thoracic Surgery (ESC/EACTS)38 guidelines on myocardial revascularisation have issued a class II recommendation for IVUS with varying levels of evidence depending on the indication.

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Use of intravascular ultrasound (IVUS) in ambiguous angiograms

Introduction

Intravascular ultrasound (IVUS) can resolve abnormalities within the coronary artery to a degree that is not possible with angiography alone. With an axial resolution of 70-200 μm and lateral resolution of 200-400 μm, IVUS can provide information on arterial wall and luminal composition that can change clinical management decisions.

Intravascular Ultrasound-guided management of diffuse stenosis

Intravascular Ultrasound-guided management of diffuse stenosis

Tuesday 24th April 2018 @ 18:00 (CEST)

Video On Demand

   
Performed By
Prof. Javier Escaned
This educational initiative is supported by  Philips Healthcare

Diffuse stenoses present a unique set of challenges related to accurate vessel sizing in the setting of remodelling, the identification of disease in segments that appear angiographically normal and achievement of optimal stent implantation both in terms of luminal dimensions and stent apposition.

As the absence of a well-defined workflow has likely hampered more widespread uptake of intravascular ultrasound (IVUS) in this setting, this webinar proposes a workflow algorithm that can help support research and clinical decision making.

Javier Escaned is Head of the Interventional Cardiology Section at Hospital Clinico San Carlos (Madrid, Spain). His main interests in the field of interventional cardiology include intracoronary imaging and physiology, complex percutaneous coronary intervention including chronic total occlusion recanalisation, and acute coronary syndromes.

He is currently principal investigator in the SYNTAX II and DEFINE FLAIR multicentre studies.

This webinar is to inform and educate interventional cardiologists and cardiac surgeons on:

  • Overcoming the challenges of diffuse stenoses treated with percutaneous coronary intervention (PCI)
  • Defining a workflow algorithm that can help support research and clinical decision making
  • Implementing a single, comprehensive approach towards contemporary intracoronary assessment and physiological interrogation
  • Interventional cardiologists, EU-wide

Interventional Echocardiography: Field of Advanced Imaging to Support Structural Heart Interventions

Cardiovascular medicine has undergone a momentous change over the past 2 decades with the development of percutaneous transcatheter interventions for structural heart disease. This field has the greatest growth in interventional cardiology for the foreseeable future.1–3 The number of patients with acquired valvular heart disease and adult congenital heart disease will only rise in the future as the population expands and ages.