Implications of Intracoronary Ultrasound Imaging for Clinical Practice

Implications of Intracoronary Ultrasound Imaging for Clinical Practice

Christos V. Bourantas (Castle Hill Hospital, UK), Katerina K. Naka (University of Ioannina, Greece), Scot Garg (Castle Hill Hospital, UK), Farqad M. Alamgir (Castle Hill Hospital, UK), Angela Hoye (Castle Hill Hospital, UK) and Lampros K. Michalis (University of Ioannina, Greece)
DOI: 10.4018/978-1-61350-095-8.ch005
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Intracoronary ultrasound (ICUS) provides detailed microscopic imaging of coronary anatomy within a living patient. These images allow visualization of lumen, outer vessel wall, and plaque and give reliable information regarding the constitution of the plaque and the extent of the atherosclerotic disease. However, although it provides supplementary information to coronary angiography which may be useful in diagnosis and treatment planning, its clinical application is limited due to the additional expense, procedure time, and the risk of complication that ICUS examination carries. In this chapter, we review the literature and summarize the clinical indications of ICUS imaging in diagnostic and therapeutic procedures.
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Although ICUS is regarded as the gold standard for assessing coronary dimensions and evaluating coronary pathology it has a limited clinical applicability. Recent data from British Cardiovascular Interventional Society indicates that ICUS imaging is only available in 60% of UK PCI’s centers, and used in less than 2.5% of PCI procedures. This paradox has been attributed to the fact that ICUS examination is expensive, can be time consuming, requires additional radiation exposure and caries a small risk of complication such as coronary dissection or abrupt vessel closure (Hausmann et al. 1995). In addition, many interventional cardiologists avoid using ICUS since they are not familiar with it, and are unaware of the potential advantages of its use.

On the other hand, new developments in coronary intervention (e.g. drug eluting stents (DES), improved guidewires) have enabled more complex lesions to be amenable to PCI; a fact which has created a greater need for more detailed visualization of coronary pathology. Thus, over the recent past there has been an increased interest in the role of ICUS in clinical practice and a trend towards more frequent use.

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