[Intra-coronary ultrasonography during angioplastic procedures]

Thanks to miniaturization and constant improvement of technologies, intracoronary ultrasound (ICUS) progressively takes its place as the best tool to accurately analyze arterial wall structure. However, its routine use during interventional procedures remains limited. ICUS provides precious informations, complementary to angiography, and guide interventional procedures on the basis of a more accurate analyze of the components of the plaque, thus improving their success rate. Since its use favorized the understanding of the different devices mechanisms (angioplasty, stents, directional and rotational atherectomy), ICUS contributed to reduce the incidence of their complications. Many studies have emphasized ICUS interest during these procedures: their results seem to be significantly improved by the way of prompting the operator to adopt an aggressive strategy (additional inflations using high pressures, combination of different techniques...) which tend to reduce the complication rate and the restenosis incidence. Actually, the restenosis rate was in all these studies [OARS (29%), ABACAS (21%) and MUSIC (8.3%)] directly associated to ICUS parameters measured immediately after treatment, particularly the residual plaque burden. Whether its use, that engender substantial cost, cannot be systematic, trained centers will probably demonstrate that a rational and suitable use lead to adopt optimal strategies and achieve improved results.