State-of-the-Art Paper
Contemporary Clinical Applications of Coronary Intravascular Ultrasound

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Intravascular ultrasound (IVUS) provides valuable information on the coronary vascular lumen and wall and has been an important tool in the cardiac catheterization laboratory for over 2 decades. The major utility of IVUS relates to optimizing stent deployment, particularly in complex lesions. In percutaneous coronary intervention with bare-metal stents, IVUS guidance reduces restenosis. In percutaneous coronary intervention with drug-eluting stents, IVUS guidance may reduce rates of stent thrombosis with little affect on restenosis. The benefit of IVUS guidance is most important in complex lesion subsets, such as left main and bifurcation lesions, where studies suggest that IVUS guidance may reduce mortality. Whereas IVUS luminal area measurements have been used to assess intermediate lesion severity, recent studies have demonstrated that IVUS accurately identifies nonischemic lesions for which percutaneous coronary intervention can be safely deferred, but cannot accurately predict hemodynamically significant lesions and should not solely be used to justify revascularization. In the current review, we focus on clinical applications of IVUS in interventional cardiology.

Key Words

intravascular ultrasound
percutaneous coronary intervention
stent

Abbreviations and Acronyms

ACC
American College of Cardiology
AHA
American Heart Association
BMS
bare-metal stent(s)
CTO
chronic total occlusion
DES
drug-eluting stent(s)
FFR
fractional flow reserve
ISA
incomplete stent apposition
IVUS
intravascular ultrasound
MLA
minimal lumen area
MSA
minimal stent area
PCI
percutaneous coronary intervention
TVR
target vessel revascularization

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Dr. Samady has received research support from Volcano Corp.

All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. McDaniel and Eshtehardi contributed equally to this manuscript. Gary S. Mintz, MD, served as Guest Editor for this paper.