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Editorials

Managing Patients With Intermediate In-Stent Restenotic Lesions

Is It "Prime Time" for Intravascular Ultrasound Imaging?

Theodore A. Bass, MD and Piera Capranzano, MD

From the Division of Cardiology, University of Florida College of Medicine, Jacksonville, Fla.

Correspondence to Theodore A. Bass, MD, Division of Cardiology, University of Florida College of Medicine, 655 West 8th Street, Jacksonville, FL 32209. E-mail ted.bass@jax.ufl.edu

Key Words: IVUS • stent • intermediate • coronary • lesions

An extract of the first 250 words of the full text is provided, because this article has no abstract.

The importance of intravascular ultrasound (IVUS) as an adjunctive technology facilitating optimal coronary interventional procedural technique has become increasingly evident over the past decade. IVUS is currently appreciated as an invaluable tool enabling better assessment of reference vessel size and coronary lesion morphology, including gross plaque characteristics and lesion length. Accordingly, the adjunctive use of IVUS with angiography offers distinct advantages in the setting of performing coronary interventions.¹ The structural information acquired by ultrasound imaging has helped us plan and better execute the optimal coronary interventional procedures to achieve improved procedural efficiency and outcomes. These benefits have become more critical as we progressively approach more complex coronary lesions with catheter-based therapies. In addition, IVUS has shown to be a useful tool to investigate other possible structural causes relating to adverse events, including stent thrombosis. Late-acquired stent malapposition, stent fracture, inadequate lesion coverage, and excessive stent overlap are all readily detected by IVUS.

Article see p 111

The most recent ACC/AHA/SCAI percutaneous coronary intervention (PCI) guidelines² equivocally address the use of preinterventional IVUS for the assessment of lesion characteristics and vessel dimensions as a means to select an optimal revascularization strategy (class IIb, level of evidence C). The importance of IVUS in assessing postprocedural results appears to be more clearly defined. Appropriate stent expansion, optimal wall apposition, and detection of postdeployment stent edge issues, such as dissections, are all well assessed by IVUS.³ Evaluation of these anatomic features has possible implications regarding the safety and efficacy of PCI.^4,5 Current ACC/AHA/SCAI PCI . . . [Full Text of this Article]

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