Clinical Application of Intracoronary Ultrasound (IVUS) and Quantitative Coronary Angiography (QCA) to Assess Coronary Intervention and Atherosclerosis

Ischemic heart disease remains a major cause of mortality and morbidity in Europe, the United States and Japan. It has been proposed that coronary atherosclerosis is the consequence of the vascular response to injurious effects of exposure to the classical cardiovascular risk factors including smoking, diabetes, hypertension and hyperlipidemia. However, the relationship between such coronary risk factors and atherosclerotic coronary plaque burden has not yet been fully elucidated. The epidemic of cardiovascular disease demands further efforts to elucidate the mechanisms of atherosclerosis and further research to develop and guide treatments. Since Andreas R. Grüntzig performed the first percutaneous transluminal coronary angioplasty on September 16th 1977, coronary intervention has become accepted as an effective therapy for patients with coronary artery disease all over the world. The initial success achieved with percutaneous coronary intervention continues to be limited by restenosis. Intracoronary ultrasound (IVUS) studies reveal that late vessel remodeling and plaque growth plays an important role in the restenosis process. Coronary stenting, by supporting the vessel wall, limits early and late vessel remodeling and subsequently decreases restenosis. More recently short- to medium-term restenosis appears to have been further ameliorated by the advent of drug-eluting stent (DES) technologies. However, several limitations still restrict the widespread application of this technique including concerns about subacute or late stent thrombosis, the limited success rates of PCI for complex lesion morphology (e.g. chronic total occlusion (CTO)) and interventional cost. The ultimate goal of interventional cardiology is to disclose the mechanism of progression and regression of coronary atherosclerosis, and to provide less invasive and more effective treatments for the patients suffering from ischemic heart disease. Each interventional device should be carefully sized and deployed using reliable techniques such as intracoronary ultrasound (IVUS) and quantitative coronary angiography (QCA).

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