Imaging in the catheterization laboratory.

Abstract

Recent work confirms that visual assessment of the effect of widely employed coronary interventions is highly inaccurate. Rapid and reliable on-line angiographic quantitation is a useful advance, but problems in the application of the technique are encountered in a substantial number of cases. New algorithms have been devised to provide a comprehensive assessment of the geometry and likely functional significance of lesions as well as an objective evaluation of lesion morphology, and recent work has provided the framework for the quantitation of diffuse disease. Studies with intravascular ultrasound confirm the inadequate sensitivity of angiography in demonstrating mild to moderate atheromatous disease in the presence of vascular remodelling. The complex wall and lumen changes after percutaneous transluminal coronary angioplasty have been extensively studied; features often inadequately identified by angiography--including mural calcification and dissection--appear to affect short- and long-term outcome. The precise clinical utility of intravascular ultrasound is a critically important question that is being addressed by a number of multicenter studies. Current evidence suggests it will become part of a more comprehensive system of coronary assessment, both as the imaging modality of choice in selected indications (such as cardiac allograft arteriopathy) and as an important adjunct to angiography in certain coronary interventions.