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Navigating the Coronary Circulation : Angiography vs IVUS Pearls and Pitfalls

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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  1. Navigating the Coronary Circulation:Angiography vs IVUSPearls and Pitfalls Philippe L. L’Allier, MD Montreal Heart Institute Tuesday, March 27, 2007

  2. Angiography:the old friend 2D Longitudinal Lumen Imaging • % Stenosis (QCA) • “Normal” Reference Diameter

  3. 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

  4. Quantitative coronary angiographyReference-catheter

  5. Quantitative coronary angiographyEdge detection

  6. Quantitative coronary Angiography

  7. Pitfall: lesion eccentricity

  8. Pitfall: lesion eccentricity

  9. Vascular Remodelling (Glagov’s phenomenon)

  10. IVUS Imaging 2D Cross-Sectional Imaging

  11. 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

  12. IVUS Imaging:Plaque Surface and Volume Transverse Plane Longitudinal Plane

  13. IVUS 3D Reconstruction: %change atheroma volume • ACC 2007: • - ERASE • ILLUSTRATE

  14. IVUS Pitfall:Imaging plane not perpendicular to vessel axis

  15. Distal LMT

  16. Distal LMT <6.0 mm2

  17. Fibrous Soft Deep calcification Superficial Ca

  18. Potentially unstable coronary lesion Echolucent

  19. 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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