IVUS: Post-Evaluation After Stenting

Abstract

Although the coronary angiography (CAG) can visualize the improvement of luminal narrowing after stent implantation in coronary atherosclerotic lesions, it only provides indirect vessel information using contrast medium because of a shadow image at stented segments as well as adjacent reference segments. Intravascular ultrasound (IVUS) is capable of generating a cross-sectional anatomy of the vessel wall comparable to corresponding histologic image, resulting in providing more information of atherosclerotic coronary plaque either quantitatively or qualitatively. On the other hand, stent struts appear as focal, bright spots at cross-sectional and longitudinal images owing to a strong echoreflection by ultrasound beam. Thus, it allows detailed information regarding stent strut expansion, intra-stent luminal condition, and plaque characteristics at adjacent reference vessel area [1]. The routine use of IVUS in daily practice is still a matter of debate in current drug-eluting stent (DES) era, however, stent optimization by IVUS immediately after stent deployment has reported to improve clinical outcomes, especially during complex percutaneous coronary intervention (PCI) [2, 3]. This chapter reviews important IVUS findings after stent implantation and its clinical relevance.