Intravascular ultrasonography in the evaluation of results of coronary angioplasty and stenting

Abstract

The main advantage of intravascular ultrasonography (IVUS) over angiography in assessing the effect of coronary interventions is the ability of IVUS to directly visualize the vessel wall. IVUS often reveals a high residual plaque burden after angiographically successful angioplasty, and this can motivate the operator to use additional, more aggressive measures in an attempt to increase lumen dimensions. Studies using IVUS imaging before and after balloon angioplasty have shown that luminal gain after percutaneous transluminal coronary angioplasty (PTCA) results from a combination of plaque reduction and vessel wall stretch. Minimal luminal area and residual area stenosis after PTCA and stent deployment, as measured by IVUS, have been shown to be predictors of restenosis. IVUS studies have pointed to vessel shrinkage, not intimal hyperplasia, as the main mechanism of restenosis after PTCA. IVUS guidance of stent deployment has often revealed inadequate stent expansion despite optimal results on angiography, leading to high-pressure stent deployment with significant additional luminal gain. Restenosis rates may be lower with IVUS-guided stent deployment.

Intravascular Ultrasound in Lower Extremity Peripheral Vascular Interventions

“…9 IVUS thus promotes better balloon and/or stent sizing, as well as appropriate stent deployment. 27 It also aids in the selection of an appropriate revascularization strategy and the need for adjunctive stenting following balloon angioplasty. Indeed, our study noted stenting to be a significant predictor of IVUS utilization.…”

Emerging Role of Intravascular Ultrasound in the Assessment of Experimental Anti-Atherosclerotic Therapies

“…It has demonstrated that restenosis results from the combination of arterial recoil, remodeling and development of neointimal hyperplasia [18]. IVUS has been used extensively in the interventional setting to guide the adequate deployment of arterial stents and in a number of studies designed to assess the efficacy of drug eluting stents in reducing restenotic complications [19,20].…”

Restenosis after balloon angioplasty and/or stent insertion - origin and prevention. A review of the literature

“…Evaluation of the results of PTA and stenting and of restenosis has been done using angiography, ultrasonography and histopathologic examinations, but all these methods have their drawbacks. The introduction of IVUS during the last decade made possible a more adequate evaluation of the lumen and the arterial wall in vivo (57, 82, 84, 116, 181, 212, 219, 222). However, placement of the IVUS catheter through a severe stenosis or occlusion can be difficult.…”

“…Diagnostic and therapeutic options have changed substantially during recent decades. Interventional treatment methods such as percutaneous transluminal angioplasty (PTA) and insertion of vascular metallic endoprostheses − stents (32, 37, 39, 57, 77, 106, 110, 145, 172) − have in many cases replaced traditional vascular surgery. However, PTA and/or the insertion of stents also causes injury to the vessel wall, followed by a healing process (48, 50, 101, 106, 165, 189).…”