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Stent/vessel diameter
Landing zone/stent length
Identify normal segments adjacent to target lesion, with plaque burden <50% at 5mm. Measure distance between distal and proximal reference point, round up to the nearest stent length.
Lesion
Assess lesion characteristics to guide plaque modification strategy.
Landing zone
Plaque burden <50% at 5 mm proximal and distal to stent edge.
Expansion and apposition
MSA ≥90% of the distal reference lumen area and full stent apposition throughout.
Stent edges
No edge dissection involving media with length > 3mm and arc ≥ 60°
The ADAPT-DES study reported that IVUS guidance was associated with a change in PCI strategy 74% of the time.2 Most often the impact was a larger size of stent or balloon, followed by post-dilation.
Furthermore, the study reported that larger stent areas resulted in cases where both pre- and post- PCI IVUS were performed compared to when only post-PCI IVUS was performed.2
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.
IVUS can help clarify 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. An important factor in your stenting strategy, calcium
is characterized by very bright areas with acoustic shadowing that
blocks out the image behind. Reverberations may also be seen.
The ADAPT-DES study reported the use of IVUS was associated with
a choice of longer stents.2 With IVUS, you can confirm “healthy-to-healthy” landing zones by checking the plaque burden and tissue type
at the lesion boundaries.
Malapposition is identified by blood behind the stent struts. ChromaFlo imaging colors blood flow red for easy recognition of malapposition and other lumen features.
The incidence of edge dissection after DES implantation is reported
to be 10%, with almost 40% of those undetected by angiography.
A dissection angle ≥60° or MLA<4mm3 indicates a high grade
dissection that should be treated. These characteristics are
associated with higher rates of early stent thrombosis.3
Stent expansion is a predictor of stent thrombosis and restenosis.
Target minimum stent areas post-PCI may include: ≥80% of the
average reference lumen areas, 6 mm3 for DES in non-LM vessels, or
other criteria depending on the type of PCI. IVUS helps document your
result.3
• Soft, tapered tip with lowest available entry profile and choice of two lengths4
• GlyDx hydrophilic coating
• Long rapid exchange lumen for pushability
• Radial access appropriate; fits through all 5F guides5
• Three radiopaque markers not offered by other IVUS catheters
• 10 mm spacing facilitates length estimation without a
pullback device or marker wire
• Easy assessment of stent apposition, lumen size and more by highlighting blood flow red at the touch of a button
• Provides advanced imaging on the IntraSight interventional applications platform with IVUS Co-registration*
*Co-registration tools available within IntraSight 7 configuration via SyncVision
1. Shlofmitz et al. IMPROVE trial: Study design and rationale. AHJ; (2020) Oct, Vol 228, doi.org/10.1016/j.ahj.2020.08.002
2. Witzenbichler B et al. Relationship Between Intravascular Ultrasound Guidance and Clinical Outcomes After Drug-Eluting Stents: The ADAPT-DES Study. Circulation
2014 Jan: 129,4;463-470.
3. McDaniel M. et al. Contemporary Clinical Applications of Coronary Intravascular Ultrasound. JACC: Cardiovascular Interventions. 2011;4 (11): 1155-67. Liu X et al. A
Volumetric Intravascular Ultrasound Comparison of Early Drug-Eluting Stent Thrombosis Versus Restenosis. JACC Cardiovasc Interv. 2009;2:428-34
4. 0.019” entry profile, data on file; tip to transducer lengths offered include 2.5 mm and 10 mm
5. Fits through guide catheters with inner diameters as low as 0.056”; data on file at Philips
