Intravascular high frequency two-dimensional ultrasound detection of arterial dissection and intimal flaps

Abstract

The anatomy of an arterial lesion has important prognostic and therapeutic implications. Current advances in interventional therapy for coronary and peripheral arterial disease have emphasized the need for more detailed morphologic information on the arterial anatomy than that derived from contrast angiography. Contrast arteriography can display dimensional narrowing of an artery. Other abnormalities such as atheromas, thrombi and dissections are not demonstrated in sufficient detail by arteriography. With fiberoptic angioscopy, some of these abnormalities can be visualized but this technique is cumbersome, requiring intermittent arterial occlusions and injections of clear fluid. Further, arterial wall architecture cannot be evaluated by fiberoptic angioscopy. Among alternate means of imaging an artery, intravascular high frequency ultrasound imaging appears promising. In vitro and in vivo studies from our laboratory and others have shown that catheter-based high frequency intravascular ultrasound imaging can provide information on the arterial wall and luminal size, and detect atheroma. 1–6 Whether this approach can identify arterial abnormalities such as small dissections and intimal flaps, commonly associated with arterial diseases, is not known. In this study we evaluated the potential of intravascular ultrasound imaging in the detection of arterial dissection and delineation of flaps from the arterial wall.