This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Request Permissions Google Scholar Articles by Maehara, A. Articles by Weissman, N. J. PubMed Articles by Maehara, A. Articles by Weissman, N. J. Related Collections Catheter-based coronary interventions: stents Coronary imaging: angiography/ultrasound/Doppler/CC Other imaging Restenosis Other arteriosclerosis

Contemporary Reviews in Interventional Cardiology

Advances in Intravascular Imaging

Akiko Maehara, MD; Gary S. Mintz, MD and Neil J. Weissman, MD

From the Cardiovascular Research Foundation, Columbia University Medical Center (A.M., G.S.M.), New York, NY; and MedStar Research Institute, Washington Hospital Center (N.J.W.), Washington, DC.

Correspondence to Neil J. Weissman, MD, MedStar Research Institute, Washington Hospital Center, 100 Irving St, NW, EB 5123, Washington, DC 20010. E-mail neil.j.weissman@medstar.net

Received March 25, 2009; accepted August 4, 2009.

Key Words: angioplasty • arteriosclerosis • imaging • restenosis • ultrasonics

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

	Introduction

 
This review updates the role of various intravascular imaging techniques (1) in the detection of vulnerable plaque and (2) during percutaneous coronary intervention (PCI), especially drug-eluting stent (DES) implantation and follow-up—including intravascular ultrasound (IVUS), virtual histology (VH-IVUS) and integrated backscatter (IB-IVUS), optical coherent tomography (OCT), near-infrared (NIR) spectroscopy, angioscopy, and MRI.

IVUS, IB-IVUS, and VH-IVUS
The current intracoronary ultrasound imaging frequency range of 20 to 45 MHz provides 70 to 200 µm axial resolution with >5 mm penetration.^1,2 Grayscale IVUS allows robust quantitative measurements including lumen, vessel, and plaque area; qualitative assessment of lesions preintervention; and quantitative assessment and complications of lesions postintervention; however, it has poor sensitivity for detecting lipid-rich plaque (67%).³ High-frequency IVUS transducers can produce better resolution that should also improve plaque characterization but at the trade off of greater ultrasound reflection from blood. Blood speckle with >40 MHz ultrasound can cause confusion when identifying the lumen-tissue border, detecting in-stent neointimal tissue, etc; but it is easily solved by saline (negative contrast) injection through the guiding catheter.⁴

Standard grayscale IVUS is limited, in part, because it uses only reflected ultrasound amplitude to formulate the image and requires significant postprocessing. In an effort to improve on the qualitative assessment of the reflected ultrasound signal, Kawasaki et al developed a plaque characterization algorithm called IB-IVUS using time domain information directly from the radiofrequency signal. This process has resulted in improved plaque characterization with a reported in vitro sensitivity of 90% and specificity or 92% for lipid-rich plaque.^5,6

In a similar effort to improve . . . [Full Text of this Article]