IVUS: INTRAVASCULAR ULTRASOUND

Other Names: IVUS; Ultrasound - coronary artery; Endovascular ultrasound

Description/Test Basics/Reasons for the test: Intravascular ultrasound (IVUS), a diagnostic procedure, is a combination of echocardiography and cardiac catheterization. IVUS is a test that uses sound waves to see inside the coronary arteries, the blood vessels that supply the heart. IVUS is rarely done as a stand-alone diagnostic procedure; it is almost always done in combination with a coronary intervention- coronary angioplasty or stenting for example. 

IVUS uses high-frequency sound waves, called ultrasound, to provide moving images of organs and systems within the body, including a moving picture of your heart. The pictures come from inside the heart rather than through the chest wall. The sound waves are produced with a device called a transducer. The transducer is attached to the end of a catheter, inserted into an artery in your groin area, and subsequently threaded through the artery and into your heart. The sound waves bounce off of the walls of the artery and return to the transducer as echoes. The echoes are converted into images on a computer monitor to produce a picture of your coronary arteries and other vessels in your body. Your physician is able to look at your arteries from the inside-out. IVUS is often done during angioplasty, but can be done during cardiac catheterization as well. IVUS, among other things, is used to:
  • Help determine stent placement 
  • Help determine how well angioplasty and stenting worked
  • View the structure of the arterial wall under observation
Test preparation/pre-test guidelines: You will be instructed to not eat or drink anything 8-12 hours prior to the test, bring all your medications with you, inform your physician and the hospital staff if you take any medications for angina, hypertension, high cholesterol, diabetes or blood-thinning medications, notify your physician and the hospital staff of any allergies, particularly to iodine, and if you might be pregnant. You will also be instructed by the hospital staff to have blood tests, an electrocardiogram, and a chest x-ray taken before the procedure. Depending on what medications you take, your physician may discontinue some of them prior to the procedure. Bring all y our medications with you. You'll be asked to use the restroom to empty your bladder. You'll also be asked to remove dentures if applicable and may need to remove jewelry that could interfere with obtaining pictures of your heart. 
 
Test process/How the test is done: Cardiac catheterization is done in a special operating room called a catheterization lab. Cardiac catheterizations are usually performed with the patient lying flat on a table with an x-ray machine above or on the side of the table. An IV line will likely be placed in your arm and a mild sedative given to relax you. You will be awake during the procedure. Just before the procedure, a nurse or technician may shave the hair from the site-arm, neck or groin- where the catheter will be inserted and a local anesthetic will be applied to numb the area. A cut will be made where the local anesthetic was applied and a plastic sheath inserted into the cut to provide access for your physician to insert the catheter, a long thin tube that is inserted in an artery or vein in your groin, neck or arm and threaded to the blood vessels to your heart. The catheter is carefully threaded into the heart using a specially-designed x-ray machine that produces real-time pictures (fluoroscopy). Once the catheter is in place, what happens next depends on why you're having the cardiac catheterization:
  • Coronary angiography:  This is the most common test that is performed in conjunction with cardiac catheterization. During angiography, a contrast dye will be injected through the catheter into the coronary arteries around your heart after taking pressure measurements inside the heart. The physician usually places the catheter in the aorta at the beginning of the arteries that supply blood to the heart. The contrast dye is then injected through the catheter. The dye blocks x rays. While flowing through the coronary arteries surrounding the heart, the physician traces the flow of this dye with an x ray machine to get a 'road map' of the heart's blood vessels. X-ray images of your heart will be taken. These x-rays, called angiograms, help your physician find the location and severity of the blockages affecting your heart's blood supply and decide on a treatment course. In a coronary angiogram, the catheter is usually placed in the artery in your groin or wrist. Many patients who have undergone coronary angiography report feeling sensitive to their heartbeats and a warm, flushing sensation when the dye is injected. This is a normal reaction that lasts for 20 to 30 seconds. The physician may ask the person to cough to help move the dye through the heart's arteries. More than one injection of dye may be used during an angiography.
  • Right heart catheterization. This procedure measures the blood flow and pressure in the right side of your heart. The catheter has special sensors in it to measure the pressure and blood flow (hemodynamics) in your heart.
  • Balloon angioplasty, with or without stenting. Percutaneous Transluminal Coronary Angioplasty is used to open a narrowed artery in or near your heart. For this procedure, the catheter likely will be inserted in the artery in your groin. A long, flexible catheter will be thread through your arteries to the narrowed artery. Then, a smaller balloon catheter will be led through the flexible catheter and inflated at the narrowed area to open it. The balloon compresses the blockage (plaque) against the arterial wall, allowing increased blood flow through the coronary artery. In many cases, your doctor will also place a mesh coil called a stent at the narrowed portion to help keep the artery open. Drug eluting stents have an anti-platelet coating that further help to reduce the chance of restenosis, or the blockage reappearing.
  • Closure of heart defects such as a hole in your heart, biopsy of the heart muscle or balloon valvuloplasty, which helps to make the heart valves open more easily.
Sometime during your procedure(s), an IVUS will be performed depending on the test being performed and the reason or reasons why your physician wants it do. As stated above, this could be for a wide variety of reasons, from helping to determine where to deploy the stent to evaluating blood flow through the coronary arteries after angioplasty and/or stent has been performed.
 
Throughout the procedure you may be asked to take deep breaths, hold your breath, cough or place your arms in various positions.
 
After the test, the catheter is removed through the sheath at the insertion site. The IV will be removed as well. When the sheath is removed, firm pressure will be applied on the insertion site to allow the puncture area to close and stop any bleeding. You may be asked to raise your leg, or sutures may be used to help close the insertion site. You’ll need to lie flat for one to six hours after the procedure to avoid serious bleeding and to allow the artery to close. You will also be bandaged.
5. Post-test guidelines: You'll probably remain hospitalized one day, maybe more, while your heart is monitored. You must remain in bed and allow the access site to heal. You will be closely monitored for any complications. Your doctor may prescribe medications such as aspirin or anticoagulants/anti-platelets to prevent blood clots. Avoid lifting more than a few pounds the first few days you‚Äôre home. Do not do any strenuous exercise for the first few days as well. Drink plenty of water and other clear fluids for at least two days- this will help rid your body of the contrast dye.  Do not shower for at least 24 hours after returning home. Avoid taking a bath for a few days. You should be able to return to work or your normal routine the week after angioplasty. Call our office immediately if: 
  • You develop chest pain or shortness of breath
  • You feel weak
  • You develop bleeding or swelling at your catheter site.
  • You have signs of infection, such as redness, swelling, drainage or fever
  • Any other symptoms or signs that concern you.
It's important that you closely follow your physician's instructions regarding your blood-thinning medications- for example, aspirin, Coumadin, plavix, clopidrogel or similar medications. Most patients who have undergone coronary angioplasty regardless of stent placement will need to take aspirin for the rest of their lives. Those who have had stent placement will need a blood-thinning medication such plavix for at least one year if they are not a high risk for bleeding. Although drug-eluting stents have been shown to reduce renarrowing in certain cases, recent research has shown that drug-eluting stents slightly raise the long-term risk for the development of blood clots, which can lead to adverse cardiac events, including heart attack and death. If you have any questions talk to your cardiologist before stopping any of these medications. If you plan on having surgery, or seeing the dentist, and they advise stopping your blood-thinning medication prior to the procedure, talk to your cardiologist first.
 
Test location: Intravascular ultrasound (IVUS) is performed at Denton Regional Medical Center and Texas Health Resources Presbyterian Hospital Denton.
 

 




HOSPITAL PRIVILEGES:   •  Denton Regional Medical Center   •  Texas Health Presbyterian Hospital Denton
   •  Muenster Memorial Hospital   •  North Texas Medical Center


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