Abstract
Intravascular ultrasound is a catheter-based imaging modality that was developed to investigate the condition of coronary arteries and assess the vulnerability of coronary atherosclerotic plaques in particular. Since its introduction in the clinic 20 years ago, use of intravascular ultrasound innovation has been relatively limited. Intravascular ultrasound remains a niche technology; its clinical practice did not vastly expand, except in Japan, where intravascular ultrasound is an appraised tool for guiding percutaneous coronary interventions. In this qualitative research study, we follow scholarship on the sociology of innovation in exploring both the current adoption practices and perspectives on the future of intravascular ultrasound. We conducted a survey of biomedical experts with experience in the technology, the practice, and the commercialization of intravascular ultrasound. The collected information enabled us to map intravascular ultrasound controversies as well as to outline the dynamics of the international network of experts that generates intravascular ultrasound innovations and uses intravascular ultrasound technologies. While the technology is praised for its capacity to measure coronary atherosclerotic plaque morphology and is steadily used in clinical research, the lack of demonstrated benefits of intravascular ultrasound guided coronary interventions emerges as the strongest factor that prevents its expansion. Furthermore, most of the controversies identified were external to intravascular ultrasound technology itself, meaning that decision making at the industrial, financial and regulatory levels are likely to determine the future of intravascular ultrasound. In light of opinions from the responding experts', a wider adoption of intravascular ultrasound as a stand-alone imaging modality seems rather uncertain, but the appeal for this technology may be renewed by improving image quality and through combination with complementary imaging modalities.
Highlights
Tremendous advances occurred during the last 40 years in the field of medical imaging of the heart and the coronary vasculature, triggered by the increasing need to reduce acute myocardial infarctions
The technology is praised in cardiovascular research since it allows for longitudinal studies of atherosclerosis progression
Intravascular ultrasound (IVUS) remains valuable as it is the only clinical tool capable of imaging plaque burden in vivo and because it is grounded in extensive scientific literature
Summary
Tremendous advances occurred during the last 40 years in the field of medical imaging of the heart and the coronary vasculature, triggered by the increasing need to reduce acute myocardial infarctions. In the early 1970’s, academic research programs focused on developing two-dimensional real-time ultrasound imaging of the heart, transferring in particular knowledge from underwater acoustics to medicine [1]. This noninvasive route led to echocardiography, an imaging modality acclaimed for its radiation free nature but lacking the resolution to image the coronary vasculature. Intravascular ultrasound (IVUS) is a catheter-based echocardiography modality that was patented in 1972 [4] and further developed to investigate the status of the coronary artery wall. Several IVUS signal processing techniques have been developed at an academic level to augment IVUS capabilities in detecting and characterizing coronary artery plaques at risk [8,9] but failed to reach clinical practice so far
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