IVUS in Peripheral Procedures

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Presentation transcript:

IVUS in Peripheral Procedures Donald B Reid Scotland

Internal Carotid Artery intima media adventitia lumen

Color Flow IVUS Irshad K, Reid DB, Miller P et al. J Endovasc Ther 2001; 8: 329-338

Angiogram Silhouette Cross-section Additionally, angiography by itself causes ambiguity. These are illustrations of the same lesion as viewed at different angles.. As you can see, in one view the lesion is 75%, in the other 26%. How many times have you seen a physician call for one more picture? This continues for several angles and they still don’t have the answer. This continues until their partner is called for advice and there is still a difference of opinion. This all could have been avoided had IVUS been performed as soon as there was a question surrounding that particular lesion. This in itself is a savings of time and patient exposure to further, unnecessary contrast injections.

Clinical use of IVUS Assesses severity of disease Measures diameters for stent choice Assesses completeness of treatment Accuracy of placement

Stent Apposition

Reid DB, Diethrich EB, Marx P et al 1996 Innominate Carotid Iliac Subclavian/ Aorta Others Patients 50 13 9 5 20 Procedures 52 15 10 5 21 Satisfactory Angio 50 14 9 5 20 Sub Optimal on 20 9 1 3 0 IVUS (40%) (64%) (11%) (60%) (0%) Mean % increase 19% 17% 10% 48% - in min stent dia Reid DB, Diethrich EB, Marx P et al 1996

Reid DB, Diethrich EB, Marx P et al 1996

Arko F, Buckley C et al. J Vasc Surg 1996 27:614-623 Bibliography Arko F, Buckley C et al. J Vasc Surg 1996 27:614-623 Use of intravascular ultrasound improves long-term clinical outcome in the endovascular management of atherosclerotic aorto-iliac occlusive disease

Limb Salvage with IVUS 39/50 ( 78% ) avoided major amputation Average follow up 1 year ( range 1 - 43 months ) 1 2 3 years Irshad K. , Rahman N , Bain D et al. 2004

8.4 Fr Aortic Probe

Aortic Arch Aneurysm

Innominate Subclavian Carotid

Thoracic Dissecting Aneurysm

S, September 2006, Pages 155–162 Diethrich EB, Irshad K & Reid DB Seminars in Vascular Surgery2006; 19: 155-162

Subclavian Carotid Diethrich EB, Irshad K & Reid DB Seminars in Vascular Surgery2006; 19: 155-162

Diethrich EB, Irshad K & Reid DB Seminars in Vascular Surgery2006; 19: 155-162

Reid DB, Diethrich EB, Marx P et al. J Endovasc Surg 1996; 3: 203-210 CAROTID IVUS Reid DB, Diethrich EB, Marx P et al. J Endovasc Surg 1996; 3: 203-210

Reid DB, Diethrich EB, Marx P et al. J Endovasc Surg 1996; 3: 203-210 CAROTID IVUS Reid DB, Diethrich EB, Marx P et al. J Endovasc Surg 1996; 3: 203-210

Virtual Histology IVUS Calcification Fibrous Plaque Fibrofatty Plaque Necrotic Core Plaque

Virtual Histology IVUS Fibrous Plaque Irshad K, Velu R, Reid AW et al . J Endovasc Ther 2007 ; 14 : 198-207 .

Following Reballooning Irshad K, Velu R, Reid AW et al . J Endovasc Ther 2007 ; 14 : 198-207 .

Cerebral FilterWire

Embolic Material in Filter Irshad K, Velu R, Reid AW et al . J Endovasc Ther 2007 ; 14 : 198-207 .

Histopathology and Plaque Progression

Thin cap fibroatheroma Intimal thickening Thin cap fibroatheroma Fibroatheroma Calcified thin cap fibroatheroma Calcified fibroatheroma Fibrocalcific

Thin cap fibroatheroma Intimal thickening Thin cap fibroatheroma Fibroatheroma Calcified thin cap fibroatheroma Calcified fibroatheroma Fibrocalcific

Type of plaque Accuracy CAPITAL STUDY Type of plaque Accuracy Thin cap fibroatheroma 99.4 % Calcified thin cap fibroatheroma 96.1 % Fibroatheroma 85.9 % Fibrocalcic 85.5 % Intimal thickening 83.4 % Calcified fibroatheroma 72.4 % Diethrich EB, Margolis PM, Reid DB et al.2007 JEndovasc Ther ; 14 : 676 - 686

Calcified Nodules Diethrich EB, Margolis PM, Reid DB et al.2007 JEndovasc Ther ; 14 : 676 - 686

CAPITAL STUDY % Necrotic core P < 0.05 Aspirin No Aspirin

Pioneer Catheter Al-Ameri H, Shin V, Mayeda G et al. J Invasive Cardiol 2009, 21: 468-72.

Clinical use of IVUS Assesses severity of disease Measures diameters for stent choice Assesses completeness of treatment Accuracy of placement