Coronary IVUS
Visualize the best path forward with IVUS
Intravascular ultrasound allows physicians to visualize blood vessels from the inside out. Cross-sectional images help assess presence and extent of disease, plaque geometry and morphology, guide wire position during lesion crossing, and stent position post-treatment. The imaging transducer emits high-frequency sound waves that echo off vessel walls and are sent back to the system in varying intensities depending on the tissue. System electronics process the signal to display the cross-sectional image.
Intravascular imaging improves outcomes and saves lives, compared to angiography alone
Class IA
The ESC recommends IVUS-guided PCI for the best clinical outcomes11
74%
of the time, IVUS use resulted in a change in PCI strategy1
46%
reduction in TVF at 1 year when IVUS was used2
45%
lower risk of cardiac death associated with IVUS3
Easily assess lesion characteristics
Assessment of vessel size
Vessel diameters may be determined at proximal and distal reference sites by obtaining lumen diameters, mid-wall diameters (halfway between lumen and vessel), or vessel diameters, in order of increasing aggressiveness. If maximum and minimum diameters are used, measurements should bisect the geometric center of the vessel rather than the center of the IVUS catheter.
Assessment of lesions
IVUS can help clarify the degree and type of stenosis (i.e, MLA, plaque burden, and calcium). While IVUS can also characterize plaque rupture, thrombus, and dissection, calcium may be more common in everyday PCI. Calcium is an important factor in your stenting strategy. It is characterized by very bright areas with acoustic shadowing and /or reverberations that may indicate calcium is present.
Assessment of lesion length
The ADAPT-DES study reported the use of IVUS was associated with a choice of longer stents.1 With IVUS, you can confirm “healthy-to-healthy” landing zones by checking the plaque burden and tissue type at the lesion boundaries.
IVUS assessment of stent malapposition
Malapposition is identified by blood behind the stent struts. ChromaFlo imaging colors blood flow red for easy recognition of malapposition and other lumen features.
Assessment of edge dissection
The incidence of edge dissection after DES implantation is reported to be 10%, with almost 40% of those undetected by angiography1. A dissection angle ≥60° or MLA<4mm2 indicates a high-grade dissection that should be treated. These characteristics are associated with higher rates of early stent thrombosis.2
Assessment of stent expansion
Stent expansion is a predictor of stent thrombosis and restenosis. Target minimum stent areas post-PCI may include: ≥90% of the average reference lumen areas, 6 mm2 for DES in non-LM vessels, or other criteria depending on the type of PCI.4 IVUS helps document your result.
IVUS Co-registration
IVUS Co-registration provides easy length measurement with manual IVUS pullback and area/diameter measurements for accurate stent sizing. This feature also provides automated, real-time side-by-side display of co-registered IVUS and angio images to help correlate critical and anatomical landmarks, especially in complex cases.3,6,7,8,9
IVUS and iFR Tri-registration
Obtain easy length measurements that combine IVUS and iFR information with the angiogram to help determine if a stent will meet the procedural objectives. Available on the IntraSight system.*
ChromaFlo
ChromaFlo, available on Philips’ imaging system, is designed to make lumen size and stent apposition instantly recognizable by highlighting the blood flow in red on the screen. With a touch of the button, ChromaFlo helps physicians identify branches, dissections, thrombus, and plaque distribution in bifurcations.
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See clearly and treat optimally with IVUS in a variety of clinical scenarios
Angiography provides information on luminal characteristics of vessels but does not provide a clear picture of the vessel and disease. However, with IVUS guidance you can see more clearly and improve patient outcomes with informed pre-stent planning and post-stent optimization.9
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Footnotes
[1] Witzenbichler B, Maehara A, Weisz G, et al. Relationship between intravascular ultrasound guidance and clinical outcomes after drug-eluting stents: the assessment of dual antiplatelet therapy with drug-eluting stents (ADAPT-DES) study. Circulation. 2014;129(4):463-470. [2] Lee JM, Choi KH, Song YB, et al. Intravascular imaging-guided or angiography-guided complex PCI. N Engl J Med 2023; 388: 1668–79 [3] Stone G, et al. Intravascular imaging-guided coronary drug-eluting stent implantation: an updated network meta-analysis. The Lancet, Volume 403, Issue 10429, 824 - 837 [4] McDaniel M. et al. Contemporary Clinical Applications of Coronary Intravascular Ultrasound. JACC: Cardiovascular Interventions. 2011;4 (11): 1155-67. [6] 202-0013.53 SRS, Sync-Rx System pg 19,24. [7] 505-0100.18, Operator’s Manual. (pg 34). [8] Kim SH, Kim YH, Kang SJ, et al. Long-term outcomes of intravascular ultrasound-guided stenting in coronary bifurcation lesions. Am J Cardiol. 2010;106(5):612-618. [9] Patel Y, Depta JP, Novak E, et al. Long-term outcomes with use of intravascular ultrasound for the treatment of coronary bifurcation lesions. Am J Cardiol. 2012;109(7):960-965. [10] A. Maehara, M. Matsumura, Z.A. Ali, G.S. Mintz, G.W. Stone. IVUS-guided versus OCT-guided coronary stent implantation. J Am Coll Cardiol Img, 10 (2017), pp. 1487- 1503.
[5]Liu X et al. A Volumetric Intravascular Ultrasound Comparison of Early Drug-Eluting Stent Thrombosis Versus Restenosis. JACC Cardiovasc Interv. 2009;2:428-34
*Co-registration tools available within IntraSight 7 configuration via SyncVision
[11] 2024 ESC Guidelines for the management of chronic coronary syndromes: Developed by the task force for the management of chronic coronary syndromes of the European Society of Cardiology (ESC) Endorsed by the European Association for Cardio-Thoracic Surgery (EACTS), European Heart Journal, 2024;, ehae177.
