Navigating the coronary circulation angiography vs ivus pearls and pitfalls
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Navigating the Coronary Circulation : Angiography vs IVUS Pearls and Pitfalls PowerPoint PPT Presentation


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Navigating the Coronary Circulation : Angiography vs IVUS Pearls and Pitfalls. Philippe L. L’Allier, MD Montreal Heart Institute Tuesday, March 27, 2007. Angiography: the old friend. 2D Longitudinal Lumen Imaging. % Stenosis (QCA) “Normal” Reference Diameter. Good

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Navigating the Coronary Circulation : Angiography vs IVUS Pearls and Pitfalls

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Navigating the coronary circulation angiography vs ivus pearls and pitfalls

Navigating the Coronary Circulation:Angiography vs IVUSPearls and Pitfalls

Philippe L. L’Allier, MD

Montreal Heart Institute

Tuesday, March 27, 2007


Angiography the old friend

Angiography:the old friend

2D Longitudinal

Lumen Imaging

  • % Stenosis (QCA)

  • “Normal” Reference Diameter


Angiography the good and the bad

Good

Extensively used > 60 years

Entire coronary anatomy, including small and distal vessels

Excellent PPV

Validated QCA

Helpful in clinical decision making

Bad

Relative % stenosis

Reference segment assessment

Eccentricity

Post PTCA/dissections

Limited correlation with physiology

Angiography: the good and the bad


Quantitative coronary angiography reference catheter

Quantitative coronary angiographyReference-catheter


Quantitative coronary angiography edge detection

Quantitative coronary angiographyEdge detection


Quantitative coronary angiography

Quantitative coronary Angiography


Navigating the coronary circulation angiography vs ivus pearls and pitfalls

Pitfall: lesion eccentricity


Navigating the coronary circulation angiography vs ivus pearls and pitfalls

Pitfall: lesion eccentricity


Vascular remodelling glagov s phenomenon

Vascular Remodelling (Glagov’s phenomenon)


Ivus imaging

IVUS Imaging

2D Cross-Sectional

Imaging


Ivus the good and the bad

Good

Tomographic views

Vessel wall + lumen visualization

Excellent NPV+PPV

Validated quantitative software

Plaque characterization

Bad

Need to instrument vessels

Limited to proximal segments

Cost

Not as well validated for clinical decision making

Limited correlation with physiology

Not always perpendicular to vessel axis

IVUS: the good and the bad


Ivus imaging plaque surface and volume

IVUS Imaging:Plaque Surface and Volume

Transverse

Plane

Longitudinal

Plane


Navigating the coronary circulation angiography vs ivus pearls and pitfalls

IVUS

3D Reconstruction:

%change atheroma volume

  • ACC 2007:

  • - ERASE

  • ILLUSTRATE


Navigating the coronary circulation angiography vs ivus pearls and pitfalls

IVUS Pitfall:Imaging plane not perpendicular to vessel axis


Distal lmt

Distal LMT


Distal lmt1

Distal LMT

<6.0 mm2


Navigating the coronary circulation angiography vs ivus pearls and pitfalls

Fibrous

Soft

Deep calcification

Superficial Ca


Navigating the coronary circulation angiography vs ivus pearls and pitfalls

Potentially unstable coronary lesion

Echolucent


Conclusions

Conclusions

  • Angio remains the most widely and conveniently used coronary imaging modality

  • IVUS has helped better use/understand angiography

  • Not IVUS vs Angio, more Angio ± IVUS

  • Need to understand the pitfalls of each technique and use them appropriately


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