Percutaneous Intracoronary Ultrasound Imaging: Initial Applications in Patients

Abstract

This study was designed to evaluate the feasibility and potential clinical utility of intracoronary ultrasound imaging in patients using a 5.5 F synthetic aperture array, over-a-wire ultrasound catheter. Thirty patients underwent percutaneous intracoronary (n = 22) or peripheral (n = 8) ultrasound imaging at the time of cardiac catheterization. Ultrasound images were compared to simultaneous digital angiograms. Correlation between ultrasonic and angiographic estimation of coronary diameters was good (r = 0.80). Morphological analysis of ultrasound images obtained in patients revealed a pattern consistent with mild-to-minimal atherosclerosis, as defined by prior in vitro studies. In 15 patients, imaging was performed during intracoronary infusion of vasoactive medications (papaverine 15 mg, nitroglycerine 100 mugm, and acetylcholine 2 x 10 -5 or 2 x 10 -6M). These medications were also infused during continuous intracoronary Doppler catheter monitoring of velocity and pressure, thus allowing calculation of volume flow and coronary resistance indices. Serial determination of ultrasound-derived epicardial vessel cross-sectional area demonstrated no change (-1 +/- 1%) after papaverine, an 8 +/- 2% increase after nitroglycerine, and a 9 +/- 3% decrease after acetylcholine. Calculated resistance fell 53 +/- 4% after acetylcholine and 60 +/- 3% after papaverine. Preliminary in vitro studies using a combination angioplasty balloon/ultrasound catheter demonstrated the ability to visualize vessel dilation in real time. We conclude that intravascular ultrasound imaging will be useful for dimensional and morphological characterization of vascular disease, for beat-to-beat monitoring of vasomotion, and potentially as a real-time adjunct to therapeutic interventions.

Reproducible coronary plaque quantification by multislice computed tomography

“…Another factor, which could have caused the larger lumen diameters by IVUS, is the injection of isosorbide dinitrate before the IVUS examination to prevent possible coronary spasm. A 10% increase in lumen surface areas has been described after injection of vasodilators, although in diseased vessels this is considerably less [25,26]. Furthermore, with QCU the vessel border is taken at the EEM.…”

Reproducible coronary plaque quantification by multislice computed tomography

“…Another factor, which could have caused the larger lumen diameters by IVUS, is the injection of isosorbide dinitrate before the IVUS examination to prevent possible coronary spasm. A 10% increase in lumen surface areas has been described after injection of vasodilators, although in diseased vessels this is considerably less [25,26]. Furthermore, with QCU the vessel border is taken at the EEM.…”

Ultrasound guided therapeutic catheters: recent developments and clinical results

“…Still, some changes that occur near the PTCA balloon, such as nearby vessel caliber, have been observed in real time. Despite the limitations, clinical researchers have been successful in obtaining pre and postangioplasty images [27].…”

Coronary intravascular imaging: a piece of history

“…A key figure in this phase was Paul Yock, associated with the University of California, San Francisco, and Stanford University. He developed and introduced one of the first non-commercial IVUS systems ( 11 ). Often referred to as the father of IVUS, Yock's system used a 20 MHz transducer and provided some of the earliest in vivo images of generic arterial structure.…”

Reproducible coronary plaque quantification by multislice computed tomography

“…Another factor, which could have caused the larger lumen diameters by IVUS, is the injection of isosorbide dinitrate before the IVUS examination to prevent possible coronary spasm. A 10% increase in lumen surface areas has been described after injection of vasodilators, although in diseased vessels this is considerably less [25,26]. Furthermore, with QCU the vessel border is taken at the EEM.…”

Ultrasound guided therapeutic catheters: recent developments and clinical results

“…Still, some changes that occur near the PTCA balloon, such as nearby vessel caliber, have been observed in real time. Despite the limitations, clinical researchers have been successful in obtaining pre and postangioplasty images [27].…”

Coronary intravascular imaging: a piece of history

“…A key figure in this phase was Paul Yock, associated with the University of California, San Francisco, and Stanford University. He developed and introduced one of the first non-commercial IVUS systems ( 11 ). Often referred to as the father of IVUS, Yock's system used a 20 MHz transducer and provided some of the earliest in vivo images of generic arterial structure.…”

Reproducible coronary plaque quantification by multislice computed tomography

“…Another factor, which could have caused the larger lumen diameters by IVUS, is the injection of isosorbide dinitrate before the IVUS examination to prevent possible coronary spasm. A 10% increase in lumen surface areas has been described after injection of vasodilators, although in diseased vessels this is considerably less [25,26]. Furthermore, with QCU the vessel border is taken at the EEM.…”

Ultrasound guided therapeutic catheters: recent developments and clinical results

“…Still, some changes that occur near the PTCA balloon, such as nearby vessel caliber, have been observed in real time. Despite the limitations, clinical researchers have been successful in obtaining pre and postangioplasty images [27].…”

Coronary intravascular imaging: a piece of history

“…A key figure in this phase was Paul Yock, associated with the University of California, San Francisco, and Stanford University. He developed and introduced one of the first non-commercial IVUS systems ( 11 ). Often referred to as the father of IVUS, Yock's system used a 20 MHz transducer and provided some of the earliest in vivo images of generic arterial structure.…”