By Paul Schoenhagen
Intravascular ultrasound (IVUS) is a tomographic imaging modality played in the course of coronary angiography that permits the simultaneous evaluation of lumen, vessel wall, and atherosclerotic plaque. IVUS has been proven because the approach to selection for the detection and serial commentary of transplant vasculopathy, and extra lately, for the serial statement of atherosclerotic plaque burden in atherosclerosis progression/regression trials. whilst played via an operator accustomed to interventional, percutaneous concepts, the speed of issues in the course of IVUS imaging is exceptionally low.
IVUS Made Easy
offers an creation to coronary imaging with intravascular ultrasound (IVUS). It includes a quick, useful textual content and corresponding illustrated IVUS pictures. The layout is uniform all through, with a non-illustrated IVUS photo displayed including an illustrated reproduction. in line with the formerly released An Atlas and handbook of Coronary Intravascular Ultrasound Imaging, this guide provides improved descriptions of the sensible facets of IVUS and contains more information briefly case shows.
The booklet starts with the main of IVUS imaging. It discusses general arterial anatomy through IVUS, photograph artifacts and IVUS measurements. It then discusses plaque (atheroma) morphology and scientific applications.
Case experiences comprise:
- Coronary arteritis
- Angiographically indeterminate lesion
- Indeterminate lesion: plaque rupture
- Intedeterminate lesion after angioplasty
- Intracoronary thrombus (2 cases)
- Complications of IVUS: dissection
- Chronic coronary arterial wall dissection at the back of stent
- Intramural hematoma post-PCI
- Serial IVUS: regression
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Extra resources for IVUS Made Easy (Volume 1)
Qxd 26 3/30/09 4:41 PM Page 26 IVUS MADE EASY Figure 24 Plaque (atheroma) measurements In this figure, two highly stenotic lesion sites are shown. Importantly, the size of the plaque and the atheroma burden of the lesion in the right panels are significantly larger, despite the similar lumen dimensions. Maximum and minimum plaque thickness The largest and shortest distance from the intimal leading edge to the EEM border along any line passing through the center of the lumen, respectively. The circumferential extent of disease is commonly classified by determining whether abnormal intimal thickening is present throughout the 360° arterial circumference.
The difference in size and shape of the vessel is illustrated in the graphics below. qxd 20 3/30/09 4:37 PM Page 20 IVUS MADE EASY Figure 20 Muscle bridge The cyclical pattern of artery size is reversed at the site of muscle bridges. Here, the artery size reaches a minimum during systole (right), caused by contraction of the muscle surrounding the vessel. practice this is often not the case, and both transducer obliquity and vessel curvature can introduce an elliptical image distortion. Transducer obliquity is especially important in large vessels, and can result in an overestimation of dimensions and a reduction in image quality36.
Qxd 3/30/09 4:43 PM Page 43 PLAQUE (ATHEROMA) MORPHOLOGY 43 and acute coronary syndromes76–78. The pathophysiologic processes responsible for plaque destabilization are incompletely understood, but systemic, and in particular inflammatory, triggers play an important role73,79–99. Conversely, fibrotic changes may increase internal plaque resistance to rupture100. The balance between inflammation and fibrosis may be an important determinant of plaque progression/regression and vulnerability101. The role of systemic triggers is supported by the recent observation that plaque destabilization in patients presenting with acute coronary syndromes is characterized by the diffuse development of multiple vulnerable lesions simultaneously78–84.