Is there still a role for intravascular ultrasound in the current practice era?

Although coronary angiogram is considered the gold standard for coronary assessment, it consistently underestimates vessel size/lesion severity, and usually misses heavy calcified plaques. Intravascular ultrasound (IVUS) technology accurately determines vessel size/lesion severity and allows a detailed plaque composition evaluation. The role of IVUS guidance after bare metal stent implantation has been explored in various trials; however, no study has tested how the pre-procedural use of IVUS might impact intervention strategy and clinical outcome. Limited studies have specifically addressed the utility of IVUS after drug-eluting stent implantation. Based on the published evidence and on our clinical experience, we support a more liberal use of IVUS, especially when approaching complex coronary lesions, and resulting in an optimal interventional result that might impact clinical outcome.