Intravascular ultrasound for evaluation of coronary arteries

Intravascular ultrasound (IVUS) has emerged form a research tool to an intrinsic part of modern invasive cardiology. The main reason is the capability to obtain "in vivo" histology. For the first time it is possible to base decisions not only on lumenograms but also on vessel wall assessment. The capabilities of IVUS can be divided in its (a) diagnostic and (b) intervention associated potentials. Diagnostic strength of IVUS is the ability to monitor compensatory coronary artery enlargement as a response to arteriosclerosis, to assess intermediate lesions, to reveal occult left main stem disease, and angiographycally "silent" arteriosclerosis. The intervention associated potentials of IVUS are the ability to allow optimal device selection, i.e. rotablators in calcified lesions or atherectomy devices in large plaque burden. The effects of PTCA on vessel wall morphology can be studied in great detail and the effect on luminal gain can be assessed almost on-line. Several groups showed, that the residual plaque area even after angiographycally successful PTCA lies still in the range of 60%. A significant reduction of this number may influence longterm outcome after PTCA. Minimal luminal areas and residual plaque area after PTCA seem to be an indicator of restenosis, while the presence or absence of dissections seem to be less predictive. Intravascular monitoring of stent expansion led to high-pressure stent deployment with significant increase in post-procedural luminal diameters and finally the ability to withhold anticoagulation in patients with optimal stent deployment. In the future, integrated devices, like balloons on intravascular ultrasound catheters, steerable catheters, integrated flow and pressure transducers, tissue characterization, and 0.018 "intravascular ultrasound guide-wires will further enhance the usefulness of IVUS.