Meaning and application of intra-coronary ultrasound (IVUS)

The article is professionally consulted by Interventional Cardiologists, Department of Medical Examination & Internal Medicine, Vinmec Hai Phong International General Hospital.

Coronary artery disease is a group of diseases that are on the rise in our country. Thanks to the development of interventional vascular techniques, the treatment of cardiovascular patients is becoming more and more effective. Intravascular ultrasound (IVUS) is an advanced technique that helps the interventionist make more accurate treatment decisions.

Intra-coronary ultrasound or IVUS is a method that uses a very small ultrasound probe (< 1mm) attached to the tip of the catheter to be inserted into the coronary artery to accurately survey the extent of coronary artery damage, imaging. and the nature of atherosclerotic plaque, accurately measuring the narrow lumen area, area and volume of plaque... IVUS is an additional diagnostic measure for coronary angiography, helping doctors to intervene with more accurate treatment decisions.

Coronary artery disease is mainly caused by causes such as atherosclerosis causing narrowing and thrombosis causing coronary artery occlusion. Coronary angiography is still considered the gold standard in the diagnosis of coronary artery disease because it provides the necessary anatomical information to help the physician prescribe appropriate treatment.
However, because coronary angiography only depicts coronary stenosis on two levels, there are limitations in assessing damage in the case of coronary arteries: angulation, short lesions, dilatation or associated coronary aneurysms. Furthermore, coronary stenosis is evaluated based on comparing the stenosis site with the (normal) reference site before and after the stenosis, on coronary angiography it is sometimes difficult to determine whether the reference site is stenosis or not. . In addition, narrowness ratings also vary widely between different readings and readers.
Outstanding efficiency of intravascular ultrasound:
Intravascular ultrasound provides images from 2D views that allow identification of coronary artery lumen characteristics at difficult to assess locations. Accurate assessment by classical coronary angiography such as the origin of the anterior interventricular artery, the common trunk of the left coronary artery, the circumflex artery, and the right coronary artery. IVUS can distinguish three structural layers of the normal coronary artery wall (inner layer, medial layer, outer layer). Intravascular ultrasound is used in coronary intervention such as determining the composition of atherosclerotic plaque, artery size and how to conduct the intervention. The use of IVUS helps to assess the lumen diameter more accurately than conventional angiography, which helps to choose the right interventional instruments for the patient. Many studies around the world have demonstrated the role of intravascular ultrasound in ensuring the success of coronary intervention procedures. Benefits of intravascular ultrasound for common trunk intervention include: IVUS accurately indicates the composition of atheroma IVUS accurately indicates the diameter and length of the common trunk IVUS helps accurately measure the distal IVUS help assess the risk of bifurcation. Intravascular ultrasound helps the doctor to have a suitable intervention strategy (preparing the lesion by pre-expanding the balloon, ensuring full coverage of the lesion, ensuring that the stent follows the coronary artery in a reasonable manner, preventing the formation of a coronary artery disease). drift of atheroma into the lateral branch). Contrast angiography cannot provide this much needed precise information.

Accurate and detailed survey of coronary artery lesions helps to make the right intervention indication in cases where only coronary angiography is difficult to make a decision such as: Injury to the left coronary artery Injury moderate stenosis on angiography (narrowing from 40% to 70% of coronary lumen diameter) Branching lesions; diffuse long-term damage. Investigate the situation of restenosis after previous stent placement. When the image of lesions on coronary angiography is difficult to assess, it is faint. Chronic occlusive coronary artery lesions: help to understand the true lumen to pass the lead. Assess whether the outcome of coronary artery stenting/intervention is optimal. Evaluation of lesions, atherosclerotic plaques and some other specific anomalies of the coronary arteries.

There are no absolute contraindications. Caution when performing IVUS: The stenosis is too severe, the calcification is too much, the pulse is angled, many thrombus, the distal vessel segment is too small. In summary, intravascular ultrasound is an advanced, safe and highly accurate technique that brings many benefits to patients such as: optimization of angioplasty results, assessment of lesions and diagnosis of disease. more exactly; specify the appropriate treatment method for the patient; reduce thrombotic complications in stents; reduce the rate of restenosis after intervention and reduce the mortality rate from coronary artery disease... contributing to reducing the cost of long-term treatment for patients.
Currently, Intra-Coronary Ultrasound has been deployed at Vinmec Hai Phong International General Hospital. The technical process and equipment at Vinmec meet international standards and are always guaranteed high quality and in accordance with the process. The technique performed by Vinmec's experienced team of leading medical doctors will give accurate and reliable results.