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Assessment of ambiguous coronary lesions by intravascular ultrasound
Dietrich Baumgart1, Michael Haude, Clemens von Birgelen Cv
1Department of Cardiology, Division of Internal Medicine, University, Essen, Germany.
Insights
Intravascular ultrasound (IVUS) offers superior morphological detail compared to coronary angiography for assessing coronary artery disease, especially ambiguous lesions. IVUS aids in accurate diagnosis, lesion characterization, and optimizing patient care during cardiac catheterization.
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
- Medical Diagnostics
Background:
- Coronary angiography, traditionally the gold standard, visualizes only the coronary artery lumen.
- Intravascular ultrasound (IVUS) provides detailed morphology of vessel walls and atherosclerotic plaque.
- New insights into atherosclerosis pathogenesis, including remodeling, have emerged from IVUS analyses.
Purpose of the Study:
- To highlight the value of IVUS in assessing ambiguous coronary lesions.
- To compare the diagnostic capabilities of IVUS and coronary angiography.
- To illustrate IVUS's role in optimizing patient care and cost-effectiveness.
Main Methods:
- Review of IVUS investigations for ambiguous coronary lesions.
- Comparison of angiographic and IVUS findings for various lesion types.
- Discussion of advantages and limitations of both imaging modalities.
Main Results:
- IVUS offers superior morphological assessment compared to angiography.
- IVUS is valuable for evaluating intermediate lesions, aneurysms, ostial lesions, and dissections.
- IVUS investigations have high success and low complication rates.
Conclusions:
- IVUS is the new gold standard for morphological assessment of coronary lesions.
- IVUS improves the accuracy of diagnosing atherosclerotic disease and defining lesion characteristics.
- IVUS optimizes patient care and cost-effectiveness in diagnostic catheterizations and interventions.
Abstract:
Until recently, coronary angiography has been regarded as the 'gold standard' for visualizing and quantifying coronary artery disease. Coronary angiography, however, is a luminographic technique revealing only the inner lumen of the coronary artery. In contrast, intravascular ultrasound investigations yield a detailed morphological description of the vessel wall and plaque characteristics. Based on these analyses, new insights into the pathogenesis of atherosclerotic coronary disease have evolved, including the remodeling phenomena. Thus, nowadays intravascular ultrasound can be regarded as the new 'gold standard' for the morphological assessment of lesion severity during cardiac catheterizations. Likewise, intracoronary Doppler and intracoronary pressure measurements have demonstrated their superiority in the functional assessment of coronary stenoses. Intravascular ultrasound investigations can be performed with high success and low complication rates. The present manuscript concentrates on the value of IVUS for the assessment of ambiguous lesions. Several forms of ambiguous lesions based on the angiographic appearance, i.e. intermediate lesion with undetermined stenosis severity, aneurysmatic widening of the coronary segment, ostial lesions, branching vessels, vessel tortuosity, main stem lesions, focal spasm, sites of plaque rupture, dissections, unclear haziness and contrast density changes are discussed and illustrated by respective angiographic and IVUS examples. Both the advantages and the limitations of angiographic and intravascular ultrasound examination are discussed in detail. In conclusion, additional intravascular ultrasound examination helps to diagnose accurately the underlying atherosclerotic disease, to define lesion characteristics and to optimize individual patient care and cost with respect to diagnostic catheterizations and coronary interventions.