Intravascular Ultrasound

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  • To assess severity and morphology of a coronary artery stenosis, particularly left main coronary disease
  • To settle discordance between symptoms or noninvasive test results and coronary angiography findings
  • To assess for stent sizing by measuring lesion length and reference vessel diameter
  • To identify complications of PCI
  • To assess for optimal stent implantation
  • To assess in-stent restenosis
  • To evaluate efficacy of anti-atherosclerotic approaches in clinical trial
  • To evaluate posttransplant vasculopathy
  • Patient refusal
  • Inability to access the femoral artery or alternative arterial cannulation site
  • Uncontrolled infection or other active acute medical condition
  • Pregnancy (fluoroscopy exposure)
  • Severe coagulopathy or INR > 2.5
  • Sterile mask, cap, gown, gloves
  • Sterile drapes
  • Sterile prep solution and sponges
  • Crash cart with resuscitation equipment (intubation equipment, suction, defibrillator, and resuscitation drugs)
  • Supplemental oxygen source and means to administer to patient (mask, nasal cannula)
  • Routine patient monitors: ECG, blood pressure cuff, pulse oximeter
  • Manifold setup and/or power contrast injector
  • 1% lidocaine for local infiltration
  • 21-gauge needle (or smaller) and syringe for local anesthesia
  • 18-gauge Seldinger/Cook needle
  • Vascular introducer sheath (various French sizes) with J-tipped wire
  • 180″ or longer 0.035″ J-tipped guidewire
  • Coronary guide catheter
  • IVUS catheter and console
  • 0.014″ guidewire
  • IV heparin
  • Equipment for placement of peripheral IV for administration of IV medications, including sedation
    • 20-gauge IV catheter
    • Alcohol or other sterile prep swab
    • Syringe and small-gauge (eg, 25- or 30-gauge) needle
    • Local anesthetic
    • Tegaderm or other tape to secure IV
    • Bandage for IV site after removal
    • Heparin lock or IV solution and tubing for peripheral IV

Sample excerpt does not include step-by-step text instructions for performing this procedure
The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

  • Patients should remain in bed for 2 to 6 hours to prevent bleeding at femoral access sites and should refrain from significant physical activity for 5 to 14 days after the procedure.
  • Patients should be cautioned to watch for swelling and bleeding at the femoral puncture site and to report these immediately to the nursing staff.
  • Patients who take metformin should be advised not to resume taking the medication for at least 48 hours after the procedure.

Complications of vascular access:

  • Bleeding
  • Vascular injury (eg, femoral artery dissection)

Complications of coronary intervention

  • Iatrogenic coronary artery dissection or perforation
  • Intracoronary thrombus
  • Coronary spasm
  • Air embolism
  • Stroke
  • Arrhythmia
  • Cardiac arrest
  • Myocardial infarction
  • Death
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