Intravascular Imaging During PCI
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Anahita Deylamsalehi, M.D.[2]
- Due to angiography limitations, intra-coronary imaging can be used to guide coronary stent implantation, especially in patients with left main coronary artery involvement or complex lesions.[1]
- Intravascular ultrasound (IVUS) and optical coherence tomography (OCT are two imaging methods that can be used to assess vasculature conditions before and after PCI.
- Both imaging methods can assist in evaluating the need for lesion preparation, stent sizing, diminishing geographic-related errors, confirming stent expansion, identifying complications, and causes of stent failure.[2]
ACA 2021 Revascularization Guideline
| Class 2a Recommendation, Level of Evidence: B-R[1] |
| 1.Intravascular ultrasound (IVUS) can be used as a procedural guidance in patients undergoing coronary stent implantation, particularly in those with left main or complex coronary artery stenting in order to diminish ischemic events.
2.Optical coherence tomography (OCT is a reasonable alternative to IVUS as an procedural guidance in patients undergoing coronary stent implantation, except in those with ostial left main disease. |
| Class 2a Recommendation, Level of Evidence: C-LD[1] |
| If stent failure occurs, both IVUS and OCT can be used to determine the mechanism of stent failure. |
Intravenous Ultrasound
- The following are the list of pre-PCI evaluations that can be done with intravascular ultrasound:[3][4]
- Full-thickness evaluation of the vessel wall
- Plaque burden
- Calcification extent
- Length of lesion
- External elastic lamina diameter for stent sizing
- The following are the list of post-PCI evaluations that can be done with intravascular ultrasound:[3][4]
Optical Coherence Tomography
- Optical coherence tomography (OCT) is capable of generating high-resolution images of vessel walls by using infrared light. This imaging method has particular advantages in the evaluation of the following:[2]
- Calcium thickness
- Lipid, thrombus, fibroatheroma, and plaque rupture
- Stent strut neointimal thickness
- Stent malposition
- Edge dissections
- The following are some of the limitations of optical coherence tomography (OCT):[1]
References
- ↑ 1.0 1.1 1.2 1.3 Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM; et al. (2022). "2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". J Am Coll Cardiol. 79 (2): e21–e129. doi:10.1016/j.jacc.2021.09.006. PMID 34895950 Check
|pmid=value (help). - ↑ 2.0 2.1 Maehara A, Matsumura M, Ali ZA, Mintz GS, Stone GW (2017). "IVUS-Guided Versus OCT-Guided Coronary Stent Implantation: A Critical Appraisal". JACC Cardiovasc Imaging. 10 (12): 1487–1503. doi:10.1016/j.jcmg.2017.09.008. PMID 29216976.
- ↑ 3.0 3.1 Steinberg DH, Mintz GS, Mandinov L, Yu A, Ellis SG, Grube E; et al. (2010). "Long-term impact of routinely detected early and late incomplete stent apposition: an integrated intravascular ultrasound analysis of the TAXUS IV, V, and VI and TAXUS ATLAS workhorse, long lesion, and direct stent studies". JACC Cardiovasc Interv. 3 (5): 486–94. doi:10.1016/j.jcin.2010.03.007. PMID 20488404.
- ↑ 4.0 4.1 Kobayashi N, Mintz GS, Witzenbichler B, Metzger DC, Rinaldi MJ, Duffy PL; et al. (2016). "Prevalence, Features, and Prognostic Importance of Edge Dissection After Drug-Eluting Stent Implantation: An ADAPT-DES Intravascular Ultrasound Substudy". Circ Cardiovasc Interv. 9 (7): e003553. doi:10.1161/CIRCINTERVENTIONS.115.003553. PMID 27402854.