IVUS imaging

Catheter-based imaging system

Intravascular ultrasound (IVUS) is a catheter-based imaging technology that allows physicians to visualize of diseased vessels from inside the artery. IVUS provides detailed and accurate measurements of lumen and vessel size, plaque area and volume, and the location of key anatomical landmarks.

How IVUS works

Image acquisition
A transducer emits high-frequency sound waves that echo off vessel walls and are sent back to the system in varying intensities depending on the tissue. System electronics process the signal to display the cross-sectional image.

Precision-guided therapy system

Precision-guided therapy system
The IVUS system offers an intuitive interface for optimal ease of use and provides your choice of IVUS and physiology on an integrated platform.

IVUS catheters

Philips Volcano provides a full line of IVUS catheters to help guide your treatment approach for both coronary and peripheral†† applications. Eagle Eye Platinum, with fast, plug-and-play simplicity, is the #1 choice of physicians for IVUS.1
IVUS catheters

Key clinical scenarios

Bioresorbable scaffolds

bioresorbable scaffolds

IVUS may be used to optimize implantation by allowing you to observe:

  • Precise vessel size
  • Lesion length
  • Presence and extent of calcium
  • Stent expansion and apposition
  • Edge complications

 

Because of the thickness and material of the struts, it is common for the struts to present on ultrasound as a double line representing the leading and trailing edges of the strut.

Left main

left main

IVUS may help to determine:

  • Lesion significance
  • Vessel sizing
  • Optimal stent deployment

Repeat patients

repeat patients

For repeat patients, IVUS may help determine:

  • Extent and mechanism of restenosis for optimal treatment strategy and for the decrease of risk of geographic miss
  • Location and amount of thrombus

Bifurcation lesions

bifurcation lesions

IVUS may help to determine:

  • Plaque distribution
  • Whether 2 stents are needed
  • Lesion length
  • Landing zones
  • Whether post-dilation is needed (especially at the proximal stent)

Ambiguous angiogram

ambiguous angiogram
IVUS may help to determine pathology at the ambiguous site to optimize your treatment strategy and device utilization.

Ostial disease

ostial disease
For ostial disease, IVUS may help to determine location of true ostium to decrease risk of geographic miss or stent struts in the ostium.

Diffuse/long lesions

diffuse/long lesions

IVUS may help to determine:

  • Vessel size and length of disease
  • Positive remodeling
  • Plaque burden
  • Stenosis

IVUS benefits

PCI strategy changed 74% of the time.2

 

The ADAPT-DES study reported that IVUS guidance was associated with a change in PCI strategy 74% of the time.2 Most often, the impact was a larger size of stent or balloon followed by post-dilation. Furthermore, the study reported that larger stent areas resulted in cases where both pre- and post-PCI IVUS were performed compared to when only post-PCI IVUS was performed.

ADAPT-DES study IVUS benefits PCI

34% reduction in MACE

 

The ADAPT-DES study reported that IVUS Guidance was associated with a 34% reduction in major adverse cardiac events (MACE) at 2 years (4.9% vs 7.4%, p < 0.001).3

ADAPT-DES study IVUS improved outcomes

Meta-analysis – largest study of IVUS guidance data

 

A large body of evidence from randomized trials, observational studies, and meta-analyses reports that IVUS guidance is associated with reduced MACE.4,5,6,7,8

IVUS meta-analysis IVUS

The Society for Cardiac Angiography and Interventions’ (SCAI) Expert consensus statement: “Definitely Beneficial”8

 

IVUS is an accurate method for helping to determine:

  • Optimal stent deployment

        -  Complete stent expansion

        -  Apposition

        -  Lack of edge dissection or other complications after implantation

  • Size of the vessel undergoing stent implantation9
IVUS screen

Quality metrics

 

In-hospital mortality is an important metric of the Medicare value-based purchasing program along with 30-day readmissions that influences hospital quality scores and Medicare’s withholding of payments.10,11 IVUS guidance was associated with 0.4% in-hospital mortality while guidance by angiography alone was associated with 0.8% in-hospital mortality (p < 0.001), a 50% reduction.5 IVUS-guided DES placement has been shown to reduce 30-day event rates.12,13

IVUS benefits quality metrics

Related technologies

  • ChromaFlo imaging

    ChromaFlo imaging

    ChromaFlo imaging highlights blood flow red at the touch of a button for easy assessment of stent apposition, lumen size, and more.

  • VH IVUS

    VH IVUS

    VH IVUS imaging provides a colorized tissue map of plaque composition with automated lumen & vessel measurements.*

* Safety and effectiveness of VH IVUS for use in the characterization of vascular lesions and tissue types has not been established

 

† Digital IVUS catheters for coronary applications

†† Digital IVUS catheters for peripheral applications

 
  1. Millenium Research Group, US Marketrack internal sales data on file
  2. Witzenbichler B, Maehara A, Weisz G, et al. Relationship between intravascular ultrasound guidance and clinical outcomes after drug-eluting stents: the assessment of dual antiplatelet therapy with drug-eluting stents (ADAPT-DES) study. Circulation. 2014;129(4):463-470.
  3. Witzenbichler B. ADAPT-DES: Two-Year Insights from the Largest IVUS Substudy. TCT 2013: Transcatheter Cardiovascular Therapeutics 25th Annual Scientific Symposium. Lecture conducted from San Francisco, CA.
  4. Ahn JM, Kang SJ, Yoon SH, et al. Meta-analysis of outcomes after intravascular ultrasound-guided versus angiography-guided drug-eluting stent implantation in 26,503 patients enrolled in three randomized trials and 14 observational studies. Am J Cardiol. 2014;113:1338-1347.
  5. Elgendy IY et al. Outomes with Intravascular Ultrasound-Guided Stent Implantation:  A Meta-Analysis of Randomized Trials in the Era of Drug-Eluting Stents. Circ Cardiovasc Interv. 2016;9:e003700
  6. Jang JS, et al. Intravascular Ultrasound-Guided Implantation of Drug-Eluting Stents to Improve Outcome, A Meta-Analysis. J Am Coll Cardiol Intv. 2014;7(3):233-243
  7. Zhang YJ, et al. Comparison of intravascular ultrasound versus angiography-guided drug-eluting stent implantation: a meta-analysis of one randomized trial and ten observational studies involving 19,619 patients. EuroIntervention. 2013;9:891-892
  8. Klersey C, et al. Use of IVUS guided coronary stenting with drug eluting stent: A systematic review and meta-analysis of randomized controlled clinical trials and high quality observational studies. Int J Cardiol. 2013 Dec 5;170(1):54-63.
  9. Lotfi A, et al. Expert consensus statement on the use of fractional flow reserve, intravascular ultrasound, and optical coherence tomography: a consensus statement of the society of cardiovascular angiography and interventions. Catheter Cardiovasc Interv. 2014;83(4):509-518.
  10. Singh V, Badheka AO, Arora S et al. Comparison of in-hospital mortality, length of hospitalization, costs, and vascular complications of percutaneous coronary interventions guided by ultrasound versus guided by angiography. Am J of Cardiol. Online 18 Feb 2015.
  11. Federal Register Volume 76, Number 160 (Thursday, August 18, 2011.) Rules and Regulations, pp. 51476-51846.
  12. Roy P, Steinberg DH, Sushinsky SJ, et al. The potential clinical utility of intravascular ultrasound guidance in patients undergoing percutaneous coronary intervention with drug-eluting stents. Eur Heart J. 2008;29(15):1851-1857.
  13. Claessen BE, Mehran R, Mintz GS, et al. Impact of intravascular ultrasound imaging on early and late clinical outcomes following percutaneous coronary intervention with drug-eluting stents. JACC Cardiovasc Interv. 2011;4(9):974-981.