Orientation of intracoronary ultrasonography: looking beyond the artery

Over the past 5 years intravascular ultrasound imaging has achieved many technical advancements both in catheter design and image quality. In addition to improved image quality that provides clear display of the endovascular structure, efficient signal penetration permits the viewing of structures beyond the artery by highlighting the perivascular structures. These perivascular landmarks, which are unique within a particular coronary segment, help provide both axial and spatial orientation during multiple imaging runs throughout a coronary artery. Orientation on the basis of veins and pericardium assists the operator to appreciate the full three-dimensional view of a particular coronary segment. This article describes several of the common perivascular structures that may be viewed from different arteries routinely imaged during coronary procedures.