Sivashanmugam S: IVUS – Seeing Beyond Angiography
Sivashanmugam S, Staff Registered Nurse at Rela Hospital, shared a post on LinkedIn:
”Intravascular Ultrasound (IVUS): Seeing Beyond Angiography
Intravascular Ultrasound (IVUS) is an advanced intracoronary imaging modality that provides real-time, cross-sectional images of coronary arteries, helping optimize diagnosis and PCI outcomes.
What is IVUS?
IVUS uses a miniature ultrasound probe mounted on a catheter to visualize the arterial wall, lumen, and plaque morphology from inside the vessel.
Why IVUS?
Unlike angiography (2D lumen view), IVUS provides:
- 360° vessel visualization
- Accurate lesion assessment
- Precise vessel sizing
- Detection of plaque characteristics (calcified, fibrous, lipid-rich)
Indications
- Assessment of ambiguous/intermediate lesions
- Left main coronary artery disease
- Optimization of stent sizing and deployment
- Evaluation of stent thrombosis or restenosis
- Guidance in complex PCI
Equipment Used
- IVUS console system
- IVUS catheter
- Guiding catheter
- Pullback device (manual/automatic)
- Heparinized saline flush
Procedure Steps
- Vascular Access (Radial/Femoral)
- Guide Catheter Engagement
- Guidewire Placement
- IVUS Catheter Advancement
- Image Acquisition (manual/auto pullback)
- Lesion Analysis and Measurements
- PCI Optimization (if required)
Key Measurements
- Lumen Area (MLA)
- Vessel Diameter
- Plaque Burden (%)
- Stent Expansion & Apposition
Complications
- Coronary spasm
- Dissection (rare)
- Arrhythmias
- Catheter-related issues
Key Nursing Responsibilities
- Prepare IVUS console and catheter
- Maintain sterile field
- Continuous ECG and hemodynamic monitoring
- Assist during catheter insertion and pullback
- Ensure proper flushing to avoid artifacts
Key Takeaway
IVUS enhances precision in PCI by guiding stent selection, ensuring optimal deployment, and reducing complications—leading to better long-term outcomes.”
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