IVUS Made Easy

120 Pages·2005·6.28 MB·English

by  Paul Schoenhagen, Anthony De Franco, Steven E. Nissen, E. Murat Tuzcu

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IVUS MADE EASY

CRC Press
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Contents
Case index viii
Contributing authors ix
Acknowledgments x
Foreword xi
Introduction xiii
1 Principle of IVUS imaging 1
1.1 Principle of IVUS examination 1
1.2 Equipment 2
1.2.1 Catheter 2
1.2.2 Pullback device 4
1.2.3 Imaging console 4
1.3 Examination technique 4
1.3.1 Safety of coronary ultrasound 5
1.3.2 System setting 6
1.3.3 Cross-sectional, longitudinal, and three-dimensional display 6
1.3.4 Radiofrequency, backscatter 7
1.3.5 Limitations of IVUS 8
2 Normal arterial anatomy by IVUS 9
2.1 The lumen 9
2.2 The vessel wall 10
2.3 The adjacent structures 11
2.4 Vessel bifurcation 13
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vi IVUS MADEEASY
3 Image artifacts 15
3.1 Guide-wire artifact 15
3.2 Ring-down and digital subtraction 15
3.3 Non-uniform rotational distortion 17
3.4 Slow flow 17
3.5 Coronary pulsation and motion artifact 19
3.6 Catheter obliquity, eccentricity 19
3.7 Calcium shadow 20
4 IVUS measurements 23
4.1 Lumen measurements 23
4.2 External elastic membrane measurements 25
4.3 Plaque (atheroma) measurements 25
4.4 Calcium measurements 27
4.5 Remodeling measurements 27
4.6 Stent measurements 28
4.7 Length measurements 30
4.8 Volumetric measurements 30
5 Plaque (atheroma) morphology 33
5.1 Geometry 33
5.1.1 Plaque size and relationship to luminal stenosis 33
5.1.2 Arterial remodeling 33
5.1.3 Eccentricity 35
5.1.4 Diffuse disease 37
5.2 Plaque echogenicity 37
5.2.1 Echolucent plaques 38
5.2.2 Echodense plaques 38
5.2.3 Calcified plaques 38

5.2.4 Mixed plaques 40
5.2.5 Thrombus 40
5.2.6 Unstable (‘vulnerable’) high-risk lesion, plaque ulceration, 41
and rupture
5.2.7 Intimal hyperplasia 45
5.2.8 Coronary venous bypass grafts 45
5.2.9 Other lesion morphology 45
6 Clinical applications 49
6.1 Assessment of angiographically indeterminate lesions 49
6.1.1 Left main coronary artery disease 49
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CONTENTS vii
6.2 Interventional applications 58
6.2.1 Pre-interventional target lesion assessment 58
6.2.2 Guidance for angioplasty and atherectomy 58
6.2.3 Guidance for stenting 61
6.2.4 Dissection, intramural hematoma, and other complications 63
after intervention
6.2.5 The restenotic lesion and in-stent restenosis 63
6.2.6 Brachytherapy and drug-coated stents 69
6.3 Serial examination of progression/regression 69
6.3.1 Matching of focal lesion sites 69
6.3.2 Matching of vessel segments and volumetric analysis 69
6.3.3 Serial assessment of transplant vasculopathy 76
6.3.4 Serial assessment of native CAD 78
7 Conclusion 93
References 95
Index 109
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Case index
Case 1, Figure 47: Coronary arteritis
Case 2, Figures 48–51: Angiographically indeterminate lesion
Case 3, Figures 52 and 53: Indeterminate lesion: plaque rupture
Case 4, Figures 54–56: Indeterminate lesion after angioplasty
Case 5, Figures 57 and 58: Intracoronary thrombus (1)
Case 6, Figures 59–62: Intracoronary thrombus (2)
Case 7, Figures 69–72: Complications of IVUS: dissection
Case 8, Figure 75 (and Figure 27): Chronic coronary arterial wall dissection
behind stent
Case 9, Figure 77: Intramural hematoma post-PCI
Case 10, Figures 107–114: Serial IVUS: regression

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Contributing authors
Paul Schoenhagen MDFAHA Anthony DeFranco MDFACC
Department of Radiology Cardiology Associates, PSC
Cardiovascular Imaging and 900 Medical Village Drive
Department of Cardiovascular Edgewood, KY 41017
Medicine
The Cleveland Clinic Foundation Timothy Crowe BS
Cleveland, OH 44195 Department of Cardiovascular
Medicine
Steven E Nissen MDFACC Technical Director
Department of Cardiovascular Intravascular Ultrasound and
Medicine Angiography Core Laboratory
Medical Director The Cleveland Clinic Foundation
Cleveland Clinic Cardiovascular Cleveland, OH 44195
Coordinating Center
The Cleveland Clinic Foundation William Magyar BS
Cleveland, OH 44195 Department of Cardiovascular
Medicine
E Murat Tuzcu MDFACC Senior Analyst
Department of Cardiovascular Intravascular Ultrasound Core
Medicine Laboratory
Interventional Cardiology The Cleveland Clinic Foundation
Medical Director Cleveland, OH 44195
Intravascular Ultrasound Core
Laboratory
The Cleveland Clinic Foundation
Cleveland, OH 44195
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Acknowledgments
We wish to acknowledge the technicians in the Intravascular Ultrasound
Core Laboratory: Jordan Andrews, Tammy Churchill, Anne Colagiovanni,
Teresa Fonk, Jessica Fox, Aaron Loyd, Andrea Winkhart, Jay Zhitnik,
and our secretary Patricia Gooch.

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Foreword
The truth is that IVUS is not all that easy – especially for those of us with the kind
of attention deficit disorder that comes with years in the cath lab. So it is appropriate
and just plain useful that Dr Schoenhagen and colleagues have brought out a
straightforward introduction to coronary IVUS.
There are a number of things to like about this guide. It’s an easy read, with
direct and clear explanations, including definitions. The figures are particularly
helpful – the authors have taken care to use a consistent format and have kept the
graphics and legends very clean. The organization is logical and tight, which makes
it useful as a ‘just-in-time’ reference as well as an evening read.
The authors are masters of the field and have contributed enormously to our
understanding of IVUS. This expertise shows through in this book, which stays
true to the literature and accurately reflects the ACC/AHA Guidelines. There is
also a consistency in approach in the book that feels like single-author text, despite
the contribution of multiple experts.
So this is a high-quality reference that has the virtues of being practical and
manageable. At the same time, it is certainly sophisticated enough to be the primary
IVUS resource for interventionalists, trainees and cath lab staff. Overall: a solid and
user-friendly contribution to the field.

Paul G Yock MD
Martha Meier Weiland Professor of Cardiovascular Medicine
Co-Chair, Department of Bioengineering
Stanford University
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