How IVUS Is Transforming Heart Diagnosis and Treatment Beyond Angiography?

Modern cardiology has witnessed remarkable progress in the diagnosis and treatment of heart diseases. Among the advanced imaging techniques, IVUS (Intravascular Ultrasound) plays a significant role in improving the understanding of coronary artery conditions. Unlike conventional angiography, which outlines the flow of dye through arteries, IVUS provides detailed images of the artery walls, offering additional insights that can guide more precise treatment decisions.

What is IVUS?

Intravascular Ultrasound (IVUS) is a catheter-based imaging technique used to visualise the inside of blood vessels, especially coronary arteries. A miniature ultrasound transducer is mounted on the tip of a thin catheter, which is gently advanced into the artery. The transducer emits high-frequency sound waves that reflect off the vessel walls and create cross-sectional images. These images allow cardiologists to assess arterial structure, plaque burden, and the extent of narrowing more accurately than with standard angiography alone.

Clinical Applications of IVUS

• Evaluate the severity and composition of artery blockages.
• Guide stent selection, positioning, and expansion during angioplasty.
• Assess the cause of recurrent symptoms after a prior stent procedure.
• Examine ambiguous or complex lesions where angiographic images are inconclusive.
• Confirm the success of coronary interventions and optimise outcomes.

How the IVUS Procedure is Performed

• The procedure is performed in a cardiac catheterisation laboratory.
• A catheter carrying the ultrasound probe is inserted through an artery in the wrist or groin and guided to the coronary arteries.
• The probe emits ultrasound waves, generating live cross-sectional images of the arterial wall.
• These images are displayed on a monitor and analysed by the cardiologist to determine vessel size, plaque buildup, and stent placement accuracy.
• The IVUS procedure is safe, minimally invasive, and generally adds only a few minutes to a standard angiogram or angioplasty.

Advantages of IVUS

• Detailed visualization: Provides high-resolution images of vessel walls and plaque composition.
• Accurate assessment: Enables precise measurement of lumen and vessel dimensions.
• Guided treatment: Supports optimal stent deployment and reduces the risk of under-expansion.
• Improved outcomes: Enhances procedural safety and long-term results for patients with coronary artery disease.

IVUS vs. Angiography

Angiography displays the lumen of the artery using contrast dye but cannot visualise the vessel wall or plaque characteristics. IVUS complements angiography by providing cross-sectional imaging that reveals hidden disease, vessel remodelling, or calcium deposits. The combined information helps physicians plan and perform coronary interventions with greater accuracy.

When IVUS May Be Recommended

• Ambiguous angiographic findings.
• Left main coronary artery disease assessment.
• Recurrent narrowing after stent placement (restenosis).
• Evaluation of stent expansion and apposition.
• Complex or heavily calcified coronary lesions.

Conclusion

Intravascular Ultrasound (IVUS) has become an integral part of modern interventional cardiology. By providing precise and real-time information about the coronary arteries, it enhances both diagnostic accuracy and treatment safety. As technology continues to advance, IVUS remains a key tool in improving outcomes for patients with coronary artery disease and guiding the next generation of evidence-based heart care.