Plaque, Stent and Ultrasound - Cardiovascular Update

Intravascular Ultrasound Outperforms Angiography for Peripheral Artery Disease Treatment

DAIC

APRIL 11, 2024

The study, called IVUS-DCB, is the first randomized controlled trial to demonstrate the clinical benefits of using IVUS in angioplasty procedures for peripheral artery disease (PAD), a condition in which plaque builds up in arteries in the legs. The study was funded by Medtronic, Inc. and Korea United Pharm.

Peripheral Arterial Disease

Peripheral Arterial Disease Ultrasound Angioplasty Plaque

Intravascular Ultrasound (IVUS) for Coronary Intervention

All About Cardiovascular System and Disorders

APRIL 10, 2024

Coronary Intravascular Ultrasound (IVUS) equipment consists of an IVUS catheter, pullback device and the imaging console. IVUS Measurements Measurements include the measurement of lumen, plaque, calcium, remodeling, stent length and volumetric measurements. Incomplete stent apposition can be detected by intravascular ultrasound.

Ultrasound

Ultrasound Plaque Stents Stent

Endovascular intervention with intravascular ultrasound guidance of very early dissection complication in transplant renal artery: a case report and literature review

Frontiers in Cardiovascular Medicine

MAY 21, 2024

We report a case of TRAD in the early postoperative period, which was successfully managed with intravascular ultrasound-assisted endovascular intervention.Case presentationA 38-year-old man underwent HLA-compatible living kidney transplantation. The transplant renal artery lesion was intervened with a stent.

Transplant

Transplant Ultrasound Plaque Atherosclerosis

Tissue characterisation and primary percutaneous coronary intervention guidance using intravascular ultrasound: rationale and design of the SPECTRUM study

Open Heart

APRIL 18, 2022

Introduction Intravascular ultrasound (IVUS) improves clinical outcome in patients undergoing percutaneous coronary intervention (PCI) but dedicated prospective studies assessing the safety and efficacy of IVUS guidance during primary PCI are lacking. Other endpoints include clinical and procedural outcomes along with post-PCI IVUS findings.

Ultrasound

Ultrasound Myocardial Infarction Cardiovascular Imaging Plaque

SCAI, SIR, and SVS Jointly Publish Proceedings from Multispecialty Peripheral IVUS Roundtable

DAIC

JANUARY 9, 2024

It provides detailed information about the vessel wall, plaque composition, and blood flow characteristics, enabling more accurate diagnosis and treatment planning. During the roundtable, participants highlighted the potential of IVUS in guiding revascularization procedures, such as angioplasty and stenting, to optimize outcomes for patients.

Peripheral Arterial Disease

Peripheral Arterial Disease Ultrasound Angioplasty Interventional Cardiology

Three normal high sensitivity troponins over 4 hours with a "normal ECG"

Dr. Smith's ECG Blog

JANUARY 5, 2024

Although it is statistically unlikely, multiple plaque ruptures are possible. On intravascular ultrasound (IVUS), the mid RCA plaque was described as "cratered, inflamed, and bulky," and the OM plaque was described as "bulky with evidence of inflammation and probably ulceration." Heitner et al.

Angina

Angina Plaque Document Stents

Concerning EKG with a Non-obstructive angiogram. What happened?

Dr. Smith's ECG Blog

DECEMBER 19, 2023

The commonest causes of MINOCA include: atherosclerotic causes such as plaque rupture or erosion with spontaneous thrombolysis, and non-atherosclerotic causes such as coronary vasospasm (sometimes called variant angina or Prinzmetal's angina), coronary embolism or thrombosis, possibly microvascular dysfunction. It is not rare.

Plaque

Plaque Angina Blog Stents

"The dye don't lie".except when it does. Angiogram Negative, or is it?

Dr. Smith's ECG Blog

SEPTEMBER 9, 2024

Smith comment : a very high proportion of MINOCA are ruptured plaque with lysed thrombus. That plaque is at risk of thrombosing again. It is worthwhile remembering that the majority of plaques which rupture are non-obstructive before they ulcerate and thrombose. Most plaque is outside the lumen!!

Plaque

Plaque Stents Stent Chest Pain

An undergraduate who is an EKG tech sees something. The computer calls it completely normal. How about the physicians?

Dr. Smith's ECG Blog

MAY 20, 2024

The scan also showed “scattered coronary artery plaques”. __ Smith comment 1 : the appropriate management at this point is to lower the blood pressure (lower afterload, which increases myocardial oxygen demand). Smith comment : Is the ACS (rupture plaque) with occlusion that is now reperfusing?

Chest Pain

Chest Pain Blood Pressure Ischemia STEMI

Mastering Cardiology: The Game Changing Power of IVUS and OCT

ADN Center of Excellence

SEPTEMBER 27, 2023

In the rapidly changing field of cardiology, IVUS (Intravascular Ultrasound) and OCT (Optical Coherence Tomography) have seen significant growth. IVUS reveals plaque characteristics, optimal stent usage, and vessel measurements. Keeping up with the times isn't a choice anymore – it's a must.

Education

Education Best Practices Innovation Stents

Chest pain, resolved. Does it need emergent cath lab activation (some controversy here)? And much much more.

Dr. Smith's ECG Blog

APRIL 22, 2024

Bedside ultrasound with no apparent wall motion abnormalities, no pericardial effusion, no right heart strain. Angiography : --Culprit for the patient's unstable angina/Wellen syndrome is a ruptured plaque in the mid LAD. --As Here are other very interesting posts: Wellens' syndrome: to stent or not?

Chest Pain

Chest Pain Myocardial Infarction Anatomy Angina

Abstract 4145631: A Rare Case of Sequential Impella Mechanical Failures due to Infective Endocarditis Vegetations

Circulation

NOVEMBER 11, 2024

Once stabilized, intravascular ultrasound showed significant thrombus and plaque in the LAD. This was treated with a drug-eluting stent, but TIMI 3 flow was not achieved. The patient was placed on an integrilin drip with plans to reevaluate in 24 hours.

Aortic valve

Aortic valve TAVR Aortic Chest Pain

Is this a STEMI? No, not by definition! Why not? Why is this Important?

Dr. Smith's ECG Blog

OCTOBER 24, 2018

This was diagnosed by IVUS (intravascular ultrasound) as a ruptured plaque. It was stented. As there was ruptured plaque, this is NOT Prinzmetal's angina. It is just as dangerous, as there is a ruptured plaque with thrombus (which lysed) in the proximal LAD. Values: STE60V3 = 2.0, QRS V2 = 10, RAV4 = 15.5,

STEMI

STEMI Angina Myocardial Infarction Plaque

Echocardiography, even (or especially) with Speckle Tracking, can get you in trouble. The ECG told the story.

Dr. Smith's ECG Blog

MARCH 28, 2017

Here are a couple shots with strain, or "speckle tracking" on ED Echo: To, me these look like anterior wall motion abnormality, but I showed them to one of our ultrasound fellows who is very interested in this. It was stented. They read it as normal. She said: This is a tough one. Learning Points : 1. Use the 4-variable formula!!

STEMI

STEMI Risk Factors Bicuspid/Mitral Ultrasound

What do heart tests tell us?

Dr. Sanjay Gupta

MARCH 6, 2022

This is an ultrasound (a bit like the type that we use on pregnant women to look at the baby). An ultrasound will allow you to visualise the heart, measure the sizes of the chambers, assess the heart valves and work out how well the heart functions as a pump. The problem with CT scanning is if you see something.

Heart Attack

Heart Attack Heart attacks Heart Rhythm Exercise

30 yo woman with trapezius pain. HEART Pathway = 0. Computer "Normal" ECG. Reality: ECG is Diagnostic of LAD Occlusion.

Dr. Smith's ECG Blog

OCTOBER 23, 2022

To, me these look like anterior wall motion abnormality, but I showed them to one of our ultrasound fellows who is very interested in this. She was treated medically for NonSTEMI, pending next day cath, which showed ulcerated plaque and a 60% thrombotic stenosis in the LAD distal to the first diagonal. It was stented.

STEMI

STEMI Chest Pain Hospital Risk Factors

A 40-Something male with a "Seizure," Hypotension, and Bradycardia

Dr. Smith's ECG Blog

OCTOBER 7, 2019

They did not have an ultrasound on the ambulance (some local crews are starting to utilize POC limited US in our service areas). He was taken to the cath lab and underwent emergent intervention: Thrombotic stenosis of the proximal RCA (95% with evidence of plaque rupture) is the culprit for the patient's inferoposterior STEMI.

Bradycardia

Bradycardia Cardiogenic Shock STEMI Ischemia

Acute chest pain and an abnormal ECG. Do precordial leads show benign T-wave inversion or ischemia?

Dr. Smith's ECG Blog

NOVEMBER 17, 2024

The operator performed intravascular ultrasound and visualized acute plaque rupture with thrombus formation and placed a stent. He is very lucky that he spontaneously reperfused and was stented before he had the chance to re-occlude. Fortunately, the patient underwent immediate angiography. 70% with normal wall motion.

Chest Pain

Chest Pain Ischemia Stents Stent

Intravascular Ultrasound Outperforms Angiography for Peripheral Artery Disease Treatment

Intravascular Ultrasound (IVUS) for Coronary Intervention

Endovascular intervention with intravascular ultrasound guidance of very early dissection complication in transplant renal artery: a case report and literature review

Tissue characterisation and primary percutaneous coronary intervention guidance using intravascular ultrasound: rationale and design of the SPECTRUM study

SCAI, SIR, and SVS Jointly Publish Proceedings from Multispecialty Peripheral IVUS Roundtable

Three normal high sensitivity troponins over 4 hours with a "normal ECG"

Concerning EKG with a Non-obstructive angiogram. What happened?

"The dye don't lie".except when it does. Angiogram Negative, or is it?

An undergraduate who is an EKG tech sees something. The computer calls it completely normal. How about the physicians?

Mastering Cardiology: The Game Changing Power of IVUS and OCT

Chest pain, resolved. Does it need emergent cath lab activation (some controversy here)? And much much more.

Abstract 4145631: A Rare Case of Sequential Impella Mechanical Failures due to Infective Endocarditis Vegetations

Is this a STEMI? No, not by definition! Why not? Why is this Important?

Echocardiography, even (or especially) with Speckle Tracking, can get you in trouble. The ECG told the story.

What do heart tests tell us?

30 yo woman with trapezius pain. HEART Pathway = 0. Computer "Normal" ECG. Reality: ECG is Diagnostic of LAD Occlusion.

A 40-Something male with a "Seizure," Hypotension, and Bradycardia

Acute chest pain and an abnormal ECG. Do precordial leads show benign T-wave inversion or ischemia?

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