[Intracoronary ultrasound: scientific aspects and clinical possibilities]

The recent development of miniaturized ultrasound devices incorporated at the tip of flexible angiographic catheters permits, for the first time in vivo, visualization of the full circumference of the vessel wall from a single tomographic view, similar to a histological study. Potential advantages of intracoronary ultrasound as compared to coronary angiography include characterization of the intramural anatomy of the vessel wall in normal and atherosclerotic segments as well as quantification of luminal dimensions and severity of stenoses using planimetry even in vessels with complex plaque morphology. Intracoronary ultrasound has therefore been called the new gold standard for vascular imaging. The method has been validated in vitro and in vivo and is highly reproducible. The complication rate of intracoronary ultrasound imaging is low. In addition to research applications, there are several emerging clinical applications for intracoronary ultrasound in the diagnosis of coronary artery disease, for instance for angiographically indeterminate lesions, in the assessment of transplant vasculopathy or in planning and guiding of coronary interventional procedures.