Current Clinical Applications of Intravascular Ultrasound in Coronary Artery Disease

Abstract

During the 20 years since the introduction of intravascular ultrasound (IVUS) to catheterization laboratory, there has been growing evidence supporting the role of IVUS. In this article, we review clinical application of routine use of IVUS with recent evidences, a dominant strategy even in the era of drug-eluting stents. IVUS provides pre-procedural information to evaluate stenosis severity and plaque characteristics. In addition, IVUS helps optimal stent deployment, minimizing underexpansion and geographic miss, which are major mechanisms of stent failure. Large-scale clinical trials and meta-analyses have shown that the clinical benefits of IVUS guidance are maximized in complex lesions (left main coronary artery, long lesions and chronic total occlusion). Some recent studies have also supported the cost effectiveness of IVUS-guided PCI especially when there is a high risk of stent failure. IVUS provides valuable information about lesion severity, lumen and vessel size, lesion length, and plaque characteristics. By determining appropriate stent sizes and optimizing stenting procedures, IVUS-guided PCI improves clinical outcomes especially in patients with high-risk coronary lesions.