An Atlas and Manual of Coronary Intravascular

Intravascular ultrasound (IVUS) is an imaging technique used during coronary angiography. This book provides a systematic introduction to coronary imaging with (IVUS). It is divided into two integrated and extensively cross-referenced parts, the Atlas and the Manual. The Manual describes the rationale, method, and interpretation of IVUS imaging for therapeutic and diagnostic purposes. It also presents a range of both established and evolving clinical and research applications. The Atlas features non-illustrated IVUS images together with corresponding illustrated figures. The reference list and subject index are connected to the Atlas and the Manual, allowing for rapid and easy access to information.

Acknowledgements

viii

List of contributing authors

ix

Editors' note

x

Foreword

xi

Section 1 The Manual of Coronary Intravascular Ultrasound Imaging

1

(28)

Introduction

3

(2)

Principles of IVUS imaging

5

(3)

Principles of IVUS examination

5

(1)

Equipment

5

(1)

Catheter

5

(1)

Pullback device

6

(1)

Imaging console

6

(1)

Examination technique

6

(2)

Safety of coronary ultrasound

6

(1)

System setting

6

(1)

Manual and motorized pullback

6

(1)

Cross-sectional, longitudinal, and three-dimensional display

7

(1)

Radiofrequency-backscatter

7

(1)

Limitations of IVUS

7

(1)

Normal arterial anatomy by IVUS

8

(2)

The lumen

8

(1)

The vessel wall

8

(1)

The adjacent structures

8

(1)

Vessel bifurcation

9

(1)

Image artifacts

10

(2)

Guide-wire artifact

10

(1)

Ring-down and digital subtraction

10

(1)

Non-uniform rotational distortion

10

(1)

Slow flow

10

(1)

Coronary pulsation and motion artifact

10

(1)

Catheter obliquity, eccentricity

11

(1)

Calcium shadow

11

(1)

IVUS measurements

12

(3)

Lumen measurements

12

(1)

EEM measurements

12

(1)

Plaque (atheroma) measurements

13

(1)

Calcium measurements

13

(1)

Remodeling measurements

13

(1)

Stent measurements

14

(1)

Length measurements

14

(1)

Volumetric measurements

14

(1)

Plaque (atheroma) morphology

15

(4)

Geometry

15

(1)

Plaque size and relationship to luminal stenosis

15

(1)

Arterial remodeling

15

(1)

Eccentricity

15

(1)

Diffuse disease

16

(1)

Plaque echogenicity

16

(3)

Echolucent plaques

16

(1)

Echodense plaques

16

(1)

Calcified plaques

16

(1)

Mixed plaque

16

(1)

Thrombus

17

(1)

Intimal hyperplasia

17

(1)

Coronary venous bypass grafts

17

(1)

Unstable ('vulnerable') high-risk lesion, plaque ulceration and rupture

17

(1)

Other lesion morphology

18

(1)

Established clinical applications

19

(4)

Assessment of angiographically indeterminate lesions

19

(1)

Left main coronary artery

19

(1)

Assessment of transplant vasculopathy

19

(1)

Interventional applications

20

(3)

Pre-interventional target lesion assessment

20

(1)

Guidance for angioplasty and atherectomy

20

(1)

Guidance for stenting

21

(1)

Dissection, intramural hematoma and other complications after intervention

21

(1)

The restenotic lesion and in-stent restonosis

21

(1)

Brachytherapy and drug-eluting stents

22

(1)

Evolving clinical and research applications

23

(5)

Assessment of plaque vulnerability

23

(2)

Morphology of focal, severely stenotic culprit lesions in patients with stable and unstable presentation

23

(1)

The rationale for prospective studies of mildly stenotic lesions

24

(1)

IVUS and other imaging modalities

25

(1)

Assessment of disease burden/volumetric analysis

25

(1)

Sequential lesions

25

(1)

Volumetric analysis

25

(1)

Serial examination of progression--regression

26

(2)

Matching

26

(1)

Progression and regression

26

(2)

Conclusion

28

(1)

Section 2 The Atlas of Coronary Intravascular Ultrasound Imaging

29

(108)

Basics of IVUS: introduction

31

(5)

Arterial anatomy

36

(5)

Image artifacts

41

(6)

IVUS measurements

47

(5)

Plaque (atheroma) morphology

52

(19)

Established clinical applications

71

(17)

Assessment of angiographically indeterminate lesions

71

(6)

Assessment of transplant vasculopathy

77

(1)

Interventional applications

78

(10)

Evolving clinical and research applications

88

(42)

Assessment of plaque vulnerability

88

(9)

Assessment of plaque burden/volumetric analysis

97

(5)

Serial examination of progression--regression of coronary artery disease

102

(28)

Case study 1: Lesion progression and subsequent PCI

130

(2)

Case study 2: PCI of lesion site and regression of an additional lesion

132

(5)

References

137

(12)

Index

149

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An Atlas and Manual of Coronary Intravascular Ultrasound Imaging

Summary

Table of Contents

Supplemental Materials