Basics of Comprehensive IVUS-Guided PCI by Junko Honye

Author:Junko Honye
Language: eng
Format: epub
ISBN: 9789811956584
Publisher: Springer Nature Singapore

The endpoint of treatment is that the flap does not expand over time and the lumen is well preserved. Intimal dissection or medial dissections less than 60° on IVUS will not cause narrowing of the lumen by the flap (Fig. 7). If there is no luminal narrowing or decreased distal blood flow after 5–10 min, no additional treatment is needed, and most dissections heal well in the chronic phase.

Fig. 7 Flap that can be observed over time

On the other hand, if the dissection is more than 90° or the hematoma is aggravated over time, the entry point should be stented to prevent luminal occlusion. Alternatively, a scoring balloon can create a reentry (IVUS is used to measure the diameter of the vessel at the hematoma site to determine the balloon size). As a result, the true lumen expands due to decompression of the false lumen (Fig. 5).

Advice

The presence or absence of dissection or hematoma after balloon dilatation or stenting should be accurately evaluated not only by angiography but also by IVUS. Once a dissection or hematoma occurs, it is important to determine if it needs to be treated immediately.

IVUS is very useful in accurately determining the location, extent of the dissection or hematoma, and whether it affects the side branches. Furthermore, IVUS provides us with appropriate treatment strategies without contrast media [1, 2].

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