Intracoronary Imaging/ Intravascular Imaging

Performing IVUS measurements

Intracoronary imaging, or intravascular imaging, is a technique used during percutaneous coronary intervention (or angioplasty) where the Cardiologist uses a special imaging catheter to look from within the coronary artery. The imaging catheter is inserted during a coronary angiogram and goes within the vessel.

Once the decision for PCI or stenting is made, the use of intracoronary imaging can greatly improve the final result of the PCI. Intracoronary imaging can accurately determine the size of the vessel, characteristics of the narrowing and importantly, help in precise sizing and placement of the stent. Interpreting the data from the images by an experienced Cardiologist is essential especially in more complex procedures.

In such cases, the information obtained from intracoronary imaging often help the Cardiologist decide on the strategy of the PCI and selecting the right devices to use to treat the narrowing. After stenting, using intracoronary imaging can help to optimise the stenting results, making sure the stent is well-placed and well-expanded. Scientific data show that using intracoronary imaging improves stenting results for better long-term outcomes for the patient.

Intravascular ultrasound (IVUS)

Intravascular ultrasound (IVUS) is an imaging technology platform that aids cardiologists in the diagnosis and treatment of cardiovascular disease. IVUS is performed during coronary angiography and angioplasty (stenting). IVUS intravascular imaging technology utilises ultrasound waves to create images to assess coronary artery disease.

During IVUS assessment, an IVUS catheter is inserted into a guiding catheter through a puncture site in the skin either at the wrist or the groin and threaded over a guidewire to the area of interest within the coronary artery. Ultrasound waves are transmitted from a miniaturized ultrasound probe on the catheter which bounces back from the vessel wall, and the information is collected and analysed to form a greyscale image of the coronary artery and its walls.

Benefits of IVUS Technology

IVUS aids the cardiologist in the assessment of lesion morphology (calcium, lipid, fibrous tissue or presence of blood clot), optimising stent selection and evaluating stent apposition, beyond what is appreciated with coronary angiography alone.

The imaging capabilities of IVUS assist cardiologists in selecting the best stent option for each patient. The system provides precise measurements of lesion dimensions and vessel size and structure, optimising treatment and follow-up strategies.

In addition to guiding stent selection, IVUS offers cardiologists post-stenting information, potentially minimising the risk of repeat revascularization will mean that the patient would have to undergo another procedure or surgery to restore blood flow to the heart. IVUS technology can provide detailed information regarding the inner lining of the coronary artery and whether there is a reoccurrence of the blood vessel narrowing.

Unlike OCT, IVUS imaging does not require contrast injection during the imaging, and this makes it more applicable for most patients.

Further advances in IVUS technology allow even greater differentiation of the composition of the plaque (using VH-IVUS – ‘virtual histology’), and even using objective assessment of how much lipid there is in the plaque (using NIRS – ‘near infrared spectroscopy’).

Is IVUS Safe?

IVUS has been used together with coronary angiography and angioplasty for about 30 years and has minimal risk to patients. Complications are rare (occurring in less than 1% of patients), which may include arrhythmias (abnormal heartbeats), hypotension (low blood pressure), or blockage, dissection, or spasm of the artery; these are related to the procedure risk of coronary angiography and angioplasty.

Optical Coherence Tomography (OCT)

Optical coherence tomography (OCT) is an imaging technology platform that aids cardiologists in the diagnosis and treatment of cardiovascular disease. OCT is performed during coronary angiography and angioplasty (stenting). OCT intravascular imaging technology utilises near-infrared light to create images with enhanced clarity for an accurate assessment of coronary artery disease.

During OCT assessment, an OCT catheter is inserted into a guiding catheter through a puncture site in the skin either at the wrist or the groin and threaded over a guidewire to the area of interest within the coronary artery. Light is emitted from a catheter which bounces back from the vessel wall, and the information is collected and analysed to form remarkably clear and detailed images.

Benefits of OCT Technology

OCT creates images with 10 times the resolution of intravascular ultrasound (IVUS) technology. The superior resolution and depth of focus found in OCT images aids in the precise assessment of lesion morphology, optimising stent selection and evaluating stent apposition.

The imaging capabilities of OCT assist cardiologists in selecting the best stent option for each patient. The system provides precise measurements of lesion dimensions and vessel size and structure, optimising treatment and follow-up strategies.

In addition to guiding stent selection, OCT offers cardiologists post-stenting information, potentially minimising the risk of repeat revascularisation. Repeat revascularisation will mean that the patient would have to undergo another procedure or surgery to restore blood flow to the heart. OCT technology can provide detailed information regarding the inner lining of the coronary arteries and whether there is a reoccurrence of the blood vessel narrowing.

Is Optical Coherence Tomography Safe?

OCT has been used together with coronary angiography and angioplasty for more than 20 years and has minimal risk to patients. Complications are rare (occurring in less than 1% of patients), which may include arrhythmias (abnormal heartbeats), hypotension (low blood pressure), or blockage, dissection, or spasm of the artery; these are related to the procedure risk of coronary angiography and angioplasty.