What Is the Clinical Utility of Intravascular Ultrasound?

This article reviews the contemporary evidence base for use of coronary intravascular ultrasound (IVUS).

Recent studies have strongly associated IVUS guidance during percutaneous coronary angioplasty (PCI) with lower major adverse cardiac events (MACE), stent thrombosis, and in selected groups, mortality. The PROSPECT study found in acute coronary syndromes patients, IVUS-determined minimal luminal area ≤ 4.0 mm² and the presence of thin-cap fibroatheromas were independent predictors of future MACE in non-culprit lesions. A sub-analysis of the ADAPT-DES trial demonstrated significant reductions in stent thrombosis, myocardial infarction, and composite MACE in patients with IVUS-guided PCI versus angiography alone. In patients with cardiac allograft vasculopathy, IVUS measurements of intimal thickening and attenuated-signal plaque are associated with increased mortality. IVUS has become a ubiquitous and versatile adjunct to conventional angiography. It is a powerful tool for identification and assessment of atherosclerotic disease, guidance of percutaneous coronary intervention, and detection of cardiac allograft vasculopathy.