Research Utility of Intravascular Ultrasound

Introduction / Background

Intravascular ultrasound (IVUS) was designed to overcome the limitations of angiographic “luminography”, and was the first intravascular coronary imaging technique to be developed. The technique has made significant contributions to our current understanding of coronary artery disease through its capacity to obtain in vivo images of the vessel wall and its interaction with coronary devices. In addition, IVUS has played a key role in the field of percutaneous coronary interventions (PCI), depicting the pitfalls of stent deployment and improving stenting techniques, a major step that has dramatically decreased peri-procedural complications, allowing the use of the simpler anti-thrombotic treatments used today. Of note, many modern trials assessing PCI are IVUS based. Knowledge of coronary vessel remodeling during atherogenesis is largely based on IVUS evidence, and many progression/regression studies of atherosclerosis are also IVUS-based. In 20 years of existence, IVUS has undergone major changes. In the last decade backscatter analysis was introduced, facilitating characterization of plaque components and its mechanical properties. Intracoronary multimodality imaging is therefore a promising technique in the study of vulnerable plaques. In complex subsets of PCI, IVUS is an indispensable tool, and new modalities for specific purposes, like forward-looking IVUS for chronic total occlusion recanalisation, are being developed. These trends will be reviewed in this chapter, along with a review of the most important uses of IVUS in current research.