Is Better IVUS the Missing Link in Peripheral Vascular Disease?

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Intravascular ultrasound has been proven to make endovascular interventions safer, and good outcomes more durable, but only a minority of clinicians use it. Two device imaging start-ups—Provisio Medical and Evident Vascular—are innovating to address barriers to the use of IVUS, with an initial focus on peripheral vascular disease, the largest potential endovascular market, and the one most in need because of the complexity of the anatomy and disease.

In early January 2024, the Journal of the Society for Cardiovascular Angiography & Interventions (JSCAI) published a report advocating for the use of intravascular ultrasound (IVUS) in peripheral arterial and deep venous interventions, the work of a multidisciplinary expert round table. Across interventional cardiology, interventional radiology, and vascular surgery, 15 physicians representing six professional societies weighed in on the value of IVUS. This was in recognition of both two decades of evidence that IVUS helps reduce adverse events during percutaneous coronary interventions (PCIs) and contributes to better outcomes, and the significant underutilization of this valuable tool in coronary and peripheral endovascular procedures.

IVUS yields far more information about vessels than conventional angiography, and two-dimensional C-arm fluoroscopy. With a cross-sectional view of the vessel, IVUS is excellent at showing stenosis, plaque burden, plaque morphology, reference vessel diameter, lesion length and eccentricity, dissections, and extrinsic and dynamic compression. It helps clinicians properly size vessels for the correct choice of pre-therapy vessel dilation strategies, stents and angioplasty balloons, to identify suitable landing zones and the presence of calcium that might need removal before stenting, to confirm the apposition of those devices to the vessel walls, and to reveal the not uncommon dissections that encourage restenosis and doom interventions to failure.


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