Equipment

A catheter consists of a miniaturized transducer and a console that reconstructs the image. High ultrasound frequencies, typically centered at 20 to 50 MHz, are used, providing excellent resolution.

Monorail rapid exchange intracoronary ultrasound catheters have an outer diameter ranging between 2.6 and 3.5 Fr (0.87-1.17 mm diameter) and can be advanced through a 6-Fr guide catheter.

Two different types of transducers are available for IVUS: the mechanically rotating transducer, and the electronically switched multielement array system.

A single rotating transducer is driven by a flexible drive cable at 1,800 rpm (30 revolutions per second) to sweep a beam almost perpendicular to the catheter. At approximately 1-degree increments, the transducer sends and receives ultrasound signals. Flushing with saline is required to provide a fluid pathway for the ultrasound beam because even small air bubbles can degrade image quality. In most mechanical systems, the transducer spins within a protective sheath while the imaging transducer is moved proximally and distally. This facilitates smooth and uniform mechanical pullback.

Electronic systems use an annular array of small crystals rather than a single rotating transducer. The transducers are activated sequentially to generate the image. The coordinated beam generated by groups of elements is known as a synthetic aperture array. Currently available electronic systems provide simultaneous colorization of blood flow.

The imaging console includes components and software necessary to convert the ultrasonography signal to a graphic image on the monitor. Three display modes are currently available:

Cross-sectional tomographic views are single-cut cross-sectional images that are limited by spatial orientation and cannot provide information regarding length and distribution of plaque.
In longitudinal imaging (L mode), computerized image reconstruction techniques present a series of evenly spaced ultrasound images along a single-cut plane to approximate the longitudinal appearance of the artery. Motorized transducer pullback and digital storage of cross-sectional images are necessary for L mode.^[31]
Three-dimensional (3D) reconstructions of data are also available.^[32]

Regarding patient preparation, local anesthesia and minimal general sedation are used, and the patient should lie supine on the angiography table.

Technique

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Media Gallery

A still intravascular ultrasonography image demonstrating a normal coronary artery.
An intravascular ultrasonography run from a segment of normal coronary artery.
An intravascular ultrasonography video highlighting the appearance of a branch from the main stem coronary artery. Note the coronary artery branch appearing at the 1'o clock position of the screen.

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Author

Kartika Shetty, MD, FACP Program Director, Internal Medicine Residency Program, Sunrise GME; Facility Medical Director, TEAMHealth, Mountain View Hospital

Kartika Shetty, MD, FACP is a member of the following medical societies: American College of Physicians, Association of Program Directors in Internal Medicine, Medical Council of India

Disclosure: Nothing to disclose.

Coauthor(s)

Nirmal Sunkara, MD Chief Resident, Department of Internal Medicine, University of Nevada School of Medicine

Nirmal Sunkara, MD is a member of the following medical societies: American College of Physicians, American Medical Association

Disclosure: Nothing to disclose.

Chowdhury H Ahsan, MD, PhD, MRCP, FSCAI Clinical Professor of Medicine, Director of Cardiac Catheterization and Intervention, Marlon Cardiac Catheterization Laboratory, Director of Cardiovascular Research, University Medical Center, University of Nevada School of Medicine

Chowdhury H Ahsan, MD, PhD, MRCP, FSCAI is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Heart Association, Society for Cardiovascular Angiography and Interventions, American Stroke Association

Disclosure: Received consulting fee from sanofi for consulting; Received honoraria from astra zeneca for speaking and teaching; Received honoraria from BI for speaking and teaching.

Chief Editor

Karlheinz Peter, MD, PhD Professor of Medicine, Monash University; Head of Centre of Thrombosis and Myocardial Infarction, Head of Division of Atherothrombosis and Vascular Biology, Associate Director, Baker Heart Research Institute; Interventional Cardiologist, The Alfred Hospital, Australia

Karlheinz Peter, MD, PhD is a member of the following medical societies: American Heart Association, German Cardiac Society, Cardiac Society of Australia and New Zealand

Disclosure: Nothing to disclose.

Additional Contributors

Subodh R Devabhaktuni, MD Assistant Professor of Medicine (Clinical Cardiac Electrophysiology), University of Arkansas for Medical Sciences College of Medicine; Cardiologist, UAMS Health

Subodh R Devabhaktuni, MD is a member of the following medical societies: American College of Cardiology, Heart Rhythm Society

Disclosure: Nothing to disclose.

Sections Intravascular Ultrasonography Procedures
Overview
Periprocedural Care
Technique
Media Gallery
References

Intravascular Ultrasonography Procedures Periprocedural Care

Equipment

References

Tables

Contributor Information and Disclosures

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