17 - Assessment of carotid plaque with intravascular ultrasound

Summary

History

Intravascular ultrasound (IVUS) has a relatively short yet highly prolific history that started in the late 1980s. The vast majority of clinical IVUS has centered on the coronary arteries with very limited studies in the carotid territory. Although this book is mainly focused on carotid disease there are a number of successful coronary IVUS techniques, which could be applied to carotid data.

Early studies already demonstrated that the extension and severity of coronary atherosclerosis might be greatly underestimated with angiography, whereas highly accurate measurements could be obtained using IVUS (Glagov et al., 1987; McPherson et al., 1987; Gussenhoven et al., 1989). Later, plaque characterization by means of the visual assessment was attempted and correlation with histopathology offered questionable results (Gussenhoven et al., 1989a, b; Peters et al., 1994). Moving forward to the core of the past decade, interventional cardiologists sought to find an application of IVUS in the catheterization laboratory. As a result, several studies evaluated the potential of IVUS as an adjunctive tool for guiding percutaneous coronary interventions. IVUS has thereafter aided the evolution of angioplasty providing insights about the morphology of atherosclerotic plaque (Suzuki et al., 1999), the mechanisms involved in the restenotic process (Hoffmann et al., 1996; Shiran et al., 1998; de Feyter et al., 1999; Sheris et al., 2000), the assessment of lesion severity (Abizaid et al., 1998, 1999; Nishioka et al., 1999; Takagi et al., 1999) and complications (Sheris et al., 2000; Degertekin et al., 2003) and the guidance of percutaneous coronary interventions (Schiele et al., 1998; Fitzgerald et al., 2000; Frey et al., 2000; Mudra et al., 2001; Oemrawsingh et al., 2003).