From vessel size to plaque morphology and geometry to guidewire position, IVUS gets you inside the vessel to acquire precise information not apparent from angiography alone. Allowing you to consistently see clearly and treat optimally.
Angiography can reveal luminal characteristics, show blood flow, and visualize the location of treatment devices. But because it delivers a 2D, outside view of the vessel, angiography has limitations when it comes to determining accurate vessel size, identifying plaque morphology, and understanding the extent of atherosclerosis.
Is this a dissection, calcium, thrombus, or stenosis?
The four pillars of IVUS
IVUS technical characteristics
A host of clinical studies have revealed the advantages of using IVUS in conjunction with angiography.
Compare outcomes with IVUS and angiography-guided PVIs1
Lower risk of periprocedural adverse events and vascular complications in the IVUS group
Visual estimate of vessel diameter by angiography vs IVUS2
Measurements estimated from the angiographic images were significantly smaller than those obtained by IVUS
One-year outcomes in femoropopliteal in-stent restenosis using directional atherectomy with IVUS-guidance vs atherectomy guided by angiography3
Clinically-driven target level revascularization was lower in IVUS-guided procedures vs angiography-guided procedures (p=0.03)
Correlation of IVUS with angiographic findings demonstrating femoropopliteal arterial dissection post atherectomy4
IVUS identified 46 post-atherectomy dissections while angiography identified 8 (p<0.01)
Validation of 3 angiographic scoring systems for PAD with IVUS5
IVUS detected calcium in 93.6% of lesions; angiography detected calcium in 55.3% of lesions (p<0.001)
IVUS-assisted vs unassisted nitinol stenting for TASC II (A-C) femoropopliteal lesions6
Analysis of 234 propensity matched pairs demonstrated higher primary patency; secondary patency; freedom from reintervention; freedom from any adverse limb event; and event free survival in IVUS-assisted procedures
1. Sheikh AB, Anantha-Narayanan M, Smolderen KG, et al. Utility of Intravascular Ultrasound in Peripheral Vascular Interventions: Systematic Review and Meta-Analysis. Vascular and Endovascular Surgery. 2020;54(5):413-422. doi:10.1177/1538574420920998. 2. Pliagas G, Saab F, Stavroulakis K, Bisdas T, Finton S, Heaney C, McGoff T, Hardy K, Adams G, Mustapha JA. Intravascular Ultrasound Imaging Versus Digital Subtraction Angiography in Patients with Peripheral Vascular Disease. J Invasive Cardiol. 2020 Mar;32(3):99-103. PMID: 32123141. 3. Krishnan P, Tarricone A, K-Raman P, et al. Intravascular ultrasound guided directional atherectomy versus directional atherectomy guided by angiography for the treatment of femoropopliteal in- stent restenosis. Ther Adv Cardiovasc Dis. 2018;12(1):17-22. doi:10.1177/1753944717745509. 4. Shammas NW, Torey JT, Shammas WJ, Jones-Miller S, Shammas GA. Intravascular Ultrasound Assessment and Correlation With Angiographic Findings Demonstrating Femoropopliteal Arterial Dissections Post Atherectomy: Results From the iDissection Study. J Invasive Cardiol. 2018 Jul;30(7):240-244. PMID: 29958175. 5. Yin D, Maehara A, Shimshak TM, Ricotta JJ 2nd, Ramaiah V, Foster MT 3rd, Davis TP, Matsumura M, Mintz GS, Gray WA. Intravascular Ultrasound Validation of Contemporary Angiographic Scores Evaluating the Severity of Calcification in Peripheral Arteries. J Endovasc Ther. 2017 Aug;24(4):478-487. doi: 10.1177/1526602817708796. Epub 2017 May 15. PMID: 28504047. 6. Iida O, Takahara M, Soga Y, Suzuki K, Hirano K, Kawasaki D, Shintani Y, Suematsu N, Yamaoka T, Nanto S, Uematsu M. Efficacy of intravascular ultrasound in femoropopliteal stenting for peripheral artery disease with TASC II class A to C lesions. J Endovasc Ther. 2014 Aug;21(4):485-92. doi: 10.1583/14-4721R.1. PMID: 25101575.
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