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Background
Intravascular ultrasound (IVUS) has been described as interesting technology in search
of a clinical application by some and by others as a valuable diagnostic tool for
many endovascular interventions. Its clinical usefulness has yet to be fully defined.
When used during endovascutar interventions, it can provide structural and diagnostic
information, assess effectiveness of the therapy, and identify treatment-related complications.
Methods
Thirty-two consecutive patients with atherosclerotic aortoiliac occlusive disease
who presented with 40 separate arterial lesions were evaluated with IVUS before and
after balloon angioplasty and intraluminal stent placement. Information obtained from
IVUS was compared with similar data obtained from simultaneous angiographic images.
Both techniques were evaluated with respect to assessment of vessel size, lesion location,
adequacy of therapy, and identification of complications.
Results
Real time IVUS imaging compared with angiographic imaging showed that in 62% of the
patients, vessel diameter was underassessed using angiographic criteria alone. More
importantly, 40% (16 of the 40 lesions) had underdeployed stents by IVUS evaluation
that appeared adequately expanded by angiographic criteria. Further stent expansion
with a larger balloon was necessary to achieve accurate stent to vessel wall apposition.
This was found to be significant by an exact binomial 95% confidence interval. Incomplete
stent deployment has been identified as a possible cause for restenosis and vessel
occlusion. Information obtained from IVUS imaging substantially altered the endovascular
therapy in approximately 40% of our patients and provided valuable vessel sizing and
lesion composition information in 62% of the patients.
Conclusion
Intravascular ultrasound can provide important diagnostic information that can alter
the conduct of selected endovascular procedures. It is especially useful when the
procedure requires deployment of arterial stents.
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Article info
Footnotes
**Presented at the 48th Annual Meeting of the Southwestern Surgical Congress, Scottsdale, Arizona, April 28–May 1, 1996.
Identification
Copyright
© 1996 Excerpta Medica, Inc. All rights reserved. Published by Elsevier Inc.
