Intravascular ultrasound-guided drug-eluting stent implantation.

Intravascular ultrasound (IVUS) enhances diagnostic assessment with identification and characterization of plaque morphology. Determination of predominant plaque morphology prior to percutaneous coronary intervention can guide optimal treatment strategy. The transducers used with IVUS catheters include solid-state, phased array systems that have multiple stationary transducers, or rotational, mechanical IVUS systems that have a single transducer that rotates on a driveshaft. Real-time online analysis with IVUS allows determination of lumen and vessel size, guiding appropriate stent selection. Following stent implantation, IVUS can assess for parameters that include stent malapposition, underexpansion, and stent edge complications. Multiple stent sizing and stent optimization strategies have been proposed. Clinical data have supported the use of IVUS for improved periprocedural and long-term outcomes, and recent guidelines have evolved to reflect this benefit. Nonetheless, worldwide utilization of intravascular imaging remains low. IVUS has particular benefit in a number of complex lesion subsets including lesions involving the left main coronary artery, severe calcification or in-stent restenosis. The use of IVUS may allow for the reduction of total contrast volume used during percutaneous coronary interventions. Intravascular imaging plays a critical role in procedural planning and stent optimization in the drug-eluting stent era. Greater utilization of IVUS for the treatment of complex lesions may further improve outcomes with drug-eluting stents.