24th ASMIHA Coverage: IVUS guided PCI
JAKARTA --- Angiography alone is not enough to assess the coronary arteries. IVUS capable of providing accurate information diameter coronary stenosis percentage, long lesions and plaque composition. In addition this method can determine the ischemic lesion size with minimal lumen area smaller than 4 mm2 and lesion length of more than 10 mm. At the bifurcation IVUS can assess access to branches and plaque morphology and lesions that are not clear. Additionally, IVUS will determine and assess ISR stent expansion, apposition, dissection and plaque shift.
IVUS guided PCI were able to decrease MACE and repeated revascularization. Stent thrombosis is a frequently feared after stent placement due improper PCI technique like under expansion, malposition and edge dissection stent. Thus, there are a number of information which should be obtained prior to intervention in order to avoid results accordingly, among others: the size of the vessels and lumen, determine the reference point distal and proximal, the extent of calcium, remodeling, the presence of atherosclerosis in the side branch, the attenuated plaque and length, plaque rupture, the dissection and hematoma, and thrombus.
Munawar, MD said that an interesting fact reflecting on his experience and a number of previous studies LM diameter is never less than 3.5 mm, while the diameter of the proximal LAD is not less than 3 mm. Therefore, for cardiologists who don't have IVUS yet, it is recommended to use this method to determine the size of the stent as a practical guide in their center.
Modified from Media Aesculapius by KM, Edited by Su