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Coronary angiography and intravascular ultrasound
1The Cleveland Clinic Foundation, Ohio 44195, USA.
Insights
Cardiovascular disease affects the vessel wall, not just the lumen. Intravascular ultrasound (IVUS) visualizes plaques, offering a new way to study atherosclerosis.
Area of Science:
- Cardiovascular medicine
- Medical imaging
Background:
- Coronary event prediction traditionally relies on lumen size and angiography.
- Cardiovascular disease fundamentally involves the vessel wall, with outward remodeling preceding luminal narrowing.
Observation:
- Atherosclerosis initially remodels the external elastic membrane outwardly.
- Luminal narrowing, detectable by angiography, occurs late in the disease progression.
- Intravascular ultrasound (IVUS) enables routine visualization of coronary plaques.
Findings:
- IVUS provides detailed arterial imaging and plaque characterization.
- Early-stage atherosclerosis involves outward remodeling, not lumen obstruction.
Implications:
- Current diagnostic methods may miss early-stage cardiovascular disease.
- IVUS can serve as a surrogate marker for evaluating atherosclerosis in clinical trials.
- Understanding vessel wall changes is crucial for effective cardiovascular drug therapy.
Abstract:
Clinicians have long used the size of the lumen and the angiogram as a predictor of coronary events. However, cardiovascular disease is not a disease of the lumen but a disease of the vessel wall. In early stages, atherosclerosis outwardly remodels the external elastic membrane; only late in the disease process does luminal narrowing occur, enabling angiographic detection. This has profound implications for drug therapy, because approximately 70% of patients present with acute myocardial infarction (MI) or sudden death, not angina as the first symptom of coronary disease. Intravascular ultrasound (IVUS) can provide detailed images of the artery and is the only technique currently available that enables physicians to routinely visualize coronary plaques. Due to its sensitivity in measuring plaque volume and content, IVUS may be a useful surrogate marker to evaluate the atherosclerotic process in smaller numbers of patients than required for conventional clinical endpoint trials.