Image-guided therapy

Coronary IVUS

Visualize the best path forward with IVUS

Intravascular ultrasound allows physicians to visualize blood vessels from the inside out. Cross-sectional images help assess presence and extent of disease, plaque geometry and morphology, guide wire position during lesion crossing and stent position post-treatment. The imaging transducer emits high-frequency sound waves that echo off vessel walls and are sent back to the system in varying intensities depending on the tissue. System electronics process the signal to display the cross-sectional image.

Demonstrated results for intravascular imaging

Class IA
The ESC recommends IVUS-guided PCI for the best clinical outcomes [11]
Class IA
The ESC recommends IVUS-guided PCI for the best clinical outcomes [11]
Intravascular imaging is now a Class IA recommendation from the ESC and should be considered when performing PCI on anatomically complex lesions, in particular left main stem, true bifurcations and long lesions.
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74%
of the time, IVUS use resulted in a change in PCI strategy [1]
74%
of the time, IVUS use resulted in a change in PCI strategy [1]
In ADAPT-DES, the largest study of IVUS use to date, IVUS guidance was associated with a reduction in stent thrombosis, myocardial infarction, and major adverse cardiac events within 1 year after DES implantation [1].
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46%
reduction in TVF at 1 year when IVUS was used [2]
46%
reduction in TVF at 1 year when IVUS was used [2]
Among patients with complex coronary-artery lesions, intravascular imaging-guided PCI led to a lower risk of a composite of death from cardiac causes, target-vessel-related myocardial infarction, or clinically driven target-vessel revascularization than angiography-guided PCI [2].
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45%
lower risk of cardiac death associated with IVUS [3]
45%
lower risk of cardiac death associated with IVUS [3]
Compared with angiography guidance, intravascular imaging guidance of coronary stent implantation with OCT or intravascular ultrasound enhances both the safety and effectiveness of PCI, reducing the risks of death, myocardial infarction, repeat revascularisation, and stent thrombosis [3].
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Assessment of vessel size

Vessel diameters may be determined at proximal and distal reference sites by obtaining lumen diameters, mid-wall diameters (halfway between lumen and vessel), or vessel diameters, in order of increasing aggressiveness. If maximum and minimum diameters are used, measurements should bisect the geometric center of the vessel rather than the center of the IVUS catheter.

Assessment of lesions

IVUS can help clarify the degree and type of stenosis (i.e, MLA, plaque burden, and calcium). While IVUS can also characterize plaque rupture, thrombus, and dissection, calcium may be more common in everyday PCI. Calcium is an important factor in your stenting strategy. It is characterized by very bright areas with acoustic shadowing and /or reverberations that may indicate calcium is present.

Assessment of lesion length

The ADAPT-DES study reported the use of IVUS was associated with a choice of longer stents [1]. With IVUS, you can confirm “healthy-to-healthy” landing zones by checking the plaque burden and tissue type at the lesion boundaries.

Image gallery

Normal-looking vessel with IVUS
Plaque with calcium
Stent with complete apposition
Stent with malapposition
Concentric Mixed Plaque
Eccentric Mixed Pl
Vessel Dissection

See clearly and treat optimally with IVUS in a variety of clinical scenarios

Angiography provides information on luminal characteristics of vessels but does not provide a clear picture of the vessel and disease. However, with IVUS guidance you can see more clearly and improve patient outcomes with informed pre-stent planning and post-stent optimization [9].

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Footnotes

Witzenbichler B, Maehara A, Weisz G, et al. Relationship between intravascular ultrasound guidance and clinical outcomes after drug-eluting stents: the assessment of dual antiplatelet therapy with drug-eluting stents (ADAPT-DES) study. Circulation. 2014;129(4):463-470.
Lee JM, Choi KH, Song YB, et al. Intravascular imaging-guided or angiography-guided complex PCI. N Engl J Med 2023; 388: 1668–79
Stone G, et al. Intravascular imaging-guided coronary drug-eluting stent implantation: an updated network meta-analysis. The Lancet, Volume 403, Issue 10429, 824 - 837
McDaniel M. et al. Contemporary Clinical Applications of Coronary Intravascular Ultrasound. JACC: Cardiovascular Interventions. 2011;4 (11): 1155-67.
Liu X et al. A Volumetric Intravascular Ultrasound Comparison of Early Drug-Eluting Stent Thrombosis Versus Restenosis. JACC Cardiovasc Interv. 2009;2:428-34
202-0013.53 SRS, Sync-Rx System pg 19,24.
505-0100.18, Operator’s Manual. (pg 34).
Kim SH, Kim YH, Kang SJ, et al. Long-term outcomes of intravascular ultrasound-guided stenting in coronary bifurcation lesions. Am J Cardiol. 2010;106(5):612-618.
Patel Y, Depta JP, Novak E, et al. Long-term outcomes with use of intravascular ultrasound for the treatment of coronary bifurcation lesions. Am J Cardiol. 2012;109(7):960-965.
A. Maehara, M. Matsumura, Z.A. Ali, G.S. Mintz, G.W. Stone. IVUS-guided versus OCT-guided coronary stent implantation. J Am Coll Cardiol Img, 10 (2017), pp. 1487- 1503. *Co-registration tools available within IntraSight 7 configuration via SyncVision
2024 ESC Guidelines for the management of chronic coronary syndromes: Developed by the task force for the management of chronic coronary syndromes of the European Society of Cardiology (ESC) Endorsed by the European Association for Cardio-Thoracic Surgery (EACTS), European Heart Journal, 2024;, ehae177.

Disclaimer

*Co-registration tools available within IntraSight 7 configuration via SyncVision

Coronary IVUS

Visualize the best path forward with IVUS

Demonstrated results for intravascular imaging

Class IA

Class IAThe ESC recommends IVUS-guided PCI for the best clinical outcomes [11]

74%

74%of the time, IVUS use resulted in a change in PCI strategy [1]

46%

46%reduction in TVF at 1 year when IVUS was used [2]

45%

45% lower risk of cardiac death associated with IVUS [3]

Image gallery

Class IA
The ESC recommends IVUS-guided PCI for the best clinical outcomes [11]

74%
of the time, IVUS use resulted in a change in PCI strategy [1]

46%
reduction in TVF at 1 year when IVUS was used [2]

45%
lower risk of cardiac death associated with IVUS [3]