Optimal assessment observation of intravascular ultrasound Katsutoshi Kawamura and Atsunori Okamura Division of Radiology Cardiovascular Center Sakurabashi Watanabe Hospital SAKURABASHI WATANABE Hospital Cardiovascular Center
Backgorund Intravascular ultrasound (IVUS) is an invasive imaging device to visualize coronary crosssectional anatomy and is superior to coronary angiography (CAG) in assessing vessel size, calcium content, and lesion severity.
Backgorund Optimal stent sizing may be clinically important in preventing incomplete stent apposition (ISA) and in optimizing initial stent deployment. It can detect some morphological alterations and may be make a prediction of some complication.
Outline Basic IVUS method Observing from proximal to distal Driven proximally from the distal Assessment of the three-layer wall Measurements for optimal stent sizing Atheroma morphology Assessment observation for the IVUS Nega-linkage 2 steps things Training method In the beginning, I will talk about the basic IVUS method, an assessment observation for the This IVUS, slide And, shows a routine a brief outline observation of my and presentation. measurements in our hospital.
BASIC IVUS METHOD First of all, let me talk about a basic IVUS method.
Basic IVUS method 1 : Observing from proximal to distal Distal Proximal As we know, using IVUS we can observe coronary cross-sectional anatomy as if we see it from the proximal to the distal portion of coronary artery.
Basic IVUS method 2 : Driven proximally from the distal Distal Proximal IVUS like this driven animation. proximally from the distal portion of coronary artery,
Basic IVUS method 3 : Assessment of the three-layer wall Media Plaque Lumen EEM IEL Catheter Adventitia As Most Moving There we left Inner is know, outward panel layer distinct the shows muscular consist from boundary the the of gray lumen, arteries, complex on scale IVUS the IVUS such of second images three as and the the layer separating elements: coronary right is the panel arteries, the intima, media, shows true which atheroma, usually adventitia a schema is have usually and from of three the internal less left IVUS layers. elastic This echogenic The surrounding trailing third atheroma image. membrane. and than edge perivascular the classifies the of most intima. the outer media by tissues. echogenicity layer matches consist the compared of external the adventitia with elastic the membrane and adventitia. periadventitial (EEM). tissues.
Basic IVUS method 4 : Measurements for optimal stent sizing Distal Proximal Plaque Plaque Lumen Media Dist. Land. Stenosis site Prox. Land. Term of the measurements Distal landing site : Lumen diameter : Stent size Stenosis site : Vessel diameter : Post dilatation balloon size Proximal landing site : Lumen diameter : Get at complete apposition Between 2 landings : Diameter of the long axis : Stent length This The In And, our lumen area here hospital, is means diameter lumen, after the plaque of IVUS proximal the examination, and distal media. landing The site. our site least So, co-medical decides we plaque can the measure site staffs stent means measure diameter. these lumen distal them The landing diameters suggest Next, point. of balloon Please at Then, the two I we The EEM can landing see or can smallest stent show this at measure the sites panel. size you stenosis lumen and for how This the PCI to size site slide length operators. vessel measure means decides shows between diameter stenosis the optimal schema balloon two at site. the landing stent of size stenosis the for sizing sites. lesion. post site. by dilatation. IVUS images.
Basic IVUS method 5 : Atheroma morphology Classed by echogenicity compared with the adventitia Soft plaque Fibrous plaque Attenuation They Next In A zone the have slide left of reduced panel, shows intermediate we the echogenicity can atheroma echogenicity see soft morphology. may plaques also between at the attributable It classifies soft position atheroma by of to echogenicity 2 a to necrotic and 7 O clock. highly zone compared echogenic They within have the with low In calcific the echogenicity plaque, the adventitia. right plaques. an intramural panel, with These we attenuation can hemorrhage, plaques see fibrous shadow. can be or plaques seen a thrombus. in at the the majority position of of atherosclerotic 12 to 5 O clock. lesion.
Basic IVUS method 5 : Atheroma morphology Classed by echogenicity compared with the adventitia Calcific plaque AS Next It can panel be also shows seen the as bright calcific echoes plaque with at the acoustic position shadowing, of 4 O clock. and IVUS the is one the accompanied most sensitive by reverberations method in or vivo multiple to detect reflections. the calcium of plaque.
ASSESSMENT OBSERVATION THE IVUS Now, let s move on to our second theme, assessment observation the IVUS.
Assessment observation the IVUS 1 : Nega-linkage Hypothesis You can not assess the IVUS Can not provide the information Get scolded Dislike the IVUS Thus, Most likely, it speaks you for will itself become that to you dislike must IVUS be able assessment to and IVUS. perhaps you will remain So, Shall You and that I call you then can t this we are imagine situation you provide assess getting will the that get Nega-linkage. to IVUS scolded information love you yet. can t IVUS by assessment. them. for the the request IVUS after of the examination? operators,
Assessment observation the IVUS 2 : 2 steps things 1. To detect : detect the morphological alterations 2. To diagnose: identify what kind of IVUS findings There is the flap There is no media at 5 O clock Medial dissection. We At first, should you report should There DETECT is the flap morphological and no media alterations. at the position And you of should 5 O clock. diagnose I One For what Now, What Then, guess the is can let s is we To it assessment the is Detect we can take the IVUS see detect a medial and look finding for them at dissection! observation IVUS in other and bottom following findings. diagnose To panel? IVUS, Diagnose. concrete the you You IVUS should example. findings. have report 2 steps. like the following.
Assessment observation the IVUS 3 : Training method 1. Running a IVUS video 2. Making a note of only lumen 3. Making a note of whole media Lumen inside of the media To observe in the whole vessel First, Next, see the IVUS same movie. video, Most Then, As I you Why In will the we suggest should commonly, You can same should see, thing, we the this whole observe it training see to would circle the observe media whole was lumen method be the until traced whole media? until lumen for you on media you detection are in the are media. satisfied. to in observe our hospital. whole vessel.
ROUTINE OBSERVATION AND MEASUREMENTS IN CLINICAL CASE Final theme is IVUS examination in case.
Routine observation and measurements in clinical case RAO Caudal View RAO Cranial View Left CAG panel revealed shows 75% the stenosis RAO caudal in the view. proximal Right LAD. panel shows the RAO cranial view.
Routine observation and measurements in clinical case Proximal LAD diffuse lesion 75% stenosis Runthrough NS wire was advanced IVUS pulled back from middle LAD 7Fr. Back up left 3.5cm Rt. FA approach ViewIT (Terumo) IVUS was used First procedure, a 7Fr back up left 3.5 guiding catheter was engaged in the left coronary Then, artery Next, we PCI through are guide going the wire right to (runthrough show femoral the IVUS approach. NS) information was advanced before in the PCI lesion. procedure.
Routine observation and measurements in clinical case
Proximal reference marking Distal reference marking Using The We measured left IVUS, panel severe shows the length calcific proximal by plaque manual marking was pull confirmed. point. back, because We ablated it can makes to the smaller lesion by gap 2.00 than mm rota-burr. After And automatic We So we decided right ablation, selected panel pull the with back. the shows lesion stent IVUS distal length which images, marking was is we the 26mm evaluated point. 2.5 between mm diameter the two stenting marking and 28 zone. mm points. length.
Routine observation and measurements in clinical case BES 2.5 x 28 mm Post deployment angiogram We deployed the BES in the lesion. Right panel shows the angiogram after stent deployment. TIMI3 flow was obtained.
Routine observation and measurements in clinical case
Routine observation and measurements in clinical case Medial dissection at distal LMCA At this time, we pointed out this IVUS finding as medial dissection to operator at the This instant panel of detection shows the it. long axis image. We can see the medial dissection at distal LMCA.
Routine observation and measurements in clinical case After 5 minutes later We Then, were waiting confirmed for it 5 minutes had no change whether the this angiogram dissection which was expanding has no changing. or not.
Conclusion Some measuring is almost measuring automatically by IVUS-staff after the examination in our hospital For the assessment observation the IVUS has 2 procedure steps which are to detect, and to diagnose For the safety and speedy procedure, I think IVUSstaff should need to point out the IVUS findings too