Free Journal 

• Remedica - Intravascular Imaging 
  http://www.remedica.com/ii/
  Intravascular Imaging is designed as a guide to the now extensive but often dispersed literature on intravascular imaging available to interventional physicians. Each issue features regular review articles on intravascular imaging techniques and summarize breaking news at the major international cardiology meetings.  Section on intravascular ultrasound, coronary flow and pressure, angioscopy, and coronary arteriography. 
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Boston Scientific Intravascular Ultrasound Lecture Series
This program is provided exclusively to TCTMD members through an educational grant by the Boston Scientific Corporation

• IVUS: When and How to Use It, by G.S. Mintz & N.J. Weissman

CME
Intravascular Ultrasound (IVUS): New Advances, New Research
Gary S. Mintz, MD
http://www.medscape.com/viewarticle/446507  

Interesting IVUS papers at the AHA
http://www.tctmd.com/meeting-news/one.html?news_item_id=2900 

TCT 2002 Presentations

• Interventional Uses of IVUS, by P. J. Fitzgerald

ESC 2002 Meeting Coverage

In-Depth Late-Breaking Clinical Trials II: BEST, PRAGUE-4, Euro-SPAH, OPTIMAAL, ACE
Luis Gruberg, MD

Summaries of important articles from major peer-reviewed journals

BEST: IVUS-guided angioplasty equivalent to stenting at 6 months
with slide / Results of a new trial suggest the results obtained with angioplasty done under ultrasound guidance are very similar at 6 months to those with bare stenting. The impact the technique will have in an era of drug-eluting stents, though, is not clear. 

Full text journal article Aug 2002
Impact of Deep Vessel Wall Injury and Vessel Stretching on Subsequent Arterial Remodeling After Balloon Angioplasty: A Serial Intravascular Ultrasound Study
Is vessel behavior after balloon angioplasty affected by the presence or absence of deep vessel wall injury?

Intravascular ultrasound guidance improves angiographic and clinical outcome of stent implantation for long coronary artery stenoses: final results of a randomized comparison with angiographic guidance (TULIP Study)
Oemrawsingh PV, et al.
Circulation 2003;107:62-7
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids= 
This study compared the 6-month outcome of stent implantation for long lesions in patients randomized to intravascular ultrasound (IVUS; n=73) or angiographic guidance (n=71). Restenosis (>50% diameter stenosis) was found in 23% of the IVUS group and 45% of the angiography group (P=0.008). At 12 months, TLR and the combined end point occurred in 10% (n=7) and 12% (n=9) of the IVUS group and 23% (n=17) and 27% (n=19) of the angiography group (P=0.018 and P=0.026), respectively. Angiographic and clinical outcome up to 12 months after long stent placement guided by IVUS is superior to guidance by angiography.

Discrepancy between angiography and intravascular ultrasound when analysing small coronary arteries
Briguori C, et al.
Eur Heart J 2002;23:247-54.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11792140  
A high percentage of vessels measuring < or =2.75 mm are large vessels with a high plaque burden. This condition is particularly prevalent in females, with lesions in the proximal or middle left anterior descending artery, and in obtuse marginal and diagonal branches

Mechanism of lumen enlargement with direct stenting versus predilatation stenting: influence of remodelling and plaque characteristics assessed by volumetric intracoronary ultrasound
Finet G, et al.
Heart 2003;89:84-90
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12482801 
In non-calcified lesions, the mechanisms of lumen enlargement after direct or predilatation stenting are significantly influenced by atherosclerotic remodelling, plaque eccentricity, and plaque composition.

Morphological and mechanical information of coronary arteries obtained with intravascular elastography; feasibility study in vivo
de Korte CL, et al.
Eur Heart J 2002;23:405-13.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11846498  
To the best of our knowledge, this is the first time that intravascular ultrasound elastography has been validated in vivo. Fatty plaques have an increased mean strain value. High-strain spots are associated with the presence of macrophages.

Intravascular ultrasonic comparisons of mechanisms of vasodilatation of cutting balloon angioplasty versus conventional balloon angioplasty
Hara H, et al.
Am J Cardiol 2002;89:1253-6.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12031723
The findings of this study suggest that the predominant mechanism of dilatation after CBA is plaque compression or shift rather than vessel expansion, unlike conventional angioplasty.

Relation between residual plaque burden after stenting and six-month angiographic restenosis
Hong MK, et al.
Am J Cardiol 2002;89:368-71.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11835912
Residual plaque burden outside the stent might not predict angiographic restenosis. IVUS stent area was the only independent predictor of angiographic restenosis

Visualization of coronary atherosclerotic plaques in patients using optical coherence tomography (OCT): comparison with intravascular ultrasound
Jang IK, et al.
J Am Coll Cardiol 2002;39:604-9.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11849858
Intracoronary OCT appears to be feasible and safe. Optical coherence tomography identified most architectural features detected by IVUS and may provide additional detailed structural information

In vivo quantitative tissue characterization of human coronary arterial plaques by use of integrated backscatter (IB) intravascular ultrasound (IVUS) and comparison with angioscopic findings
Kawasaki M, et al.
Circulation 2002;105:2487-92.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12034654
http://www.circulationaha.org/cgi/content/full/105/21/2487
http://www.circulationaha.org/cgi/content/abstract/105/21/2487
IB-IVUS represents a new and useful tool for evaluating the tissue structure of human coronary arterial plaques.

Incidence, morphology, angiographic findings, and outcomes of intramural hematomas after percutaneous coronary interventions: an intravascular ultrasound study
Maehara A, et al.
Circulation 2002;105:2037-42.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11980682
http://www.circulationaha.org/cgi/content/full/105/17/2037
http://www.circulationaha.org/cgi/content/abstract/105/17/2037
Intravascular ultrasound identified intramural hematomas after 6.7% of PCIs. The mechanism appeared to be a dissection into the media where blood accumulated because of a lack of re-entry. A third of ultrasound-identified hematomas showed no angiographic abnormalities. There was a high rate of non-Q-wave myocardial infarction, need for repeat revascularization, and sudden death in patients with hematomas.

Outcome of nonobstructive residual dissections (RDs) detected by intravascular ultrasound following percutaneous coronary intervention
Nishida T, et al.
Am J Cardiol 2002;89:1257-62.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12031724
Most nonobstructive RDs are "favorable" and do not need stent implantation. IVUS evaluation identifies "unfavorable" nonobstructive (or non-flow-limiting) dissections that might be prone to acute occlusion. Nonobstructive dissections can be left untreated when final IVUS reveals an area stenosis of < 60% at the site of a dissection

Application of intravascular ultrasound to characterize coronary artery disease and assess the progression or regression of atherosclerosis
Nissen SE.
Am J Cardiol 2002;89:24B-31B.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11879665
IVUS is likely to emerge as the "gold standard" in the study of atherosclerosis progression-regression over the next few years

Mechanisms of acute gain and late lumen loss after atherectomy in different preintervention arterial remodeling patterns
Oikawa Y, et al.
Am J Cardiol 2002;89:505-10.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11867032
Coronary artery restenosis after atherectomy was primarily due to an increase in plaque in the positive and/or intermediate remodeling groups. However, in the negative remodeling group, late lumen loss might have been caused by both an increase in plaque and vessel shrinkage.

Volumetric intravascular ultrasound quantification of the amount of atherosclerosis and calcium in nonstenotic arterial segments
Tinana A, et al.
Am J Cardiol 2002;89:757-60.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11897220

Predictors and outcomes of stent thrombosis. An intravascular ultrasound registry
Uren NG, et al.
Eur Heart J 2002;23:124-32.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11785994
On comparison with angiography, the vast majority of stents associated with subsequent thrombosis have at least one abnormal feature by intravascular ultrasound at the time of stent deployment

Relationship between coronary artery remodeling and plaque vulnerability
Varnava AM, et al.
Circulation 2002;105:939-43.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11864922
http://www.circulationaha.org/cgi/content/full/105/8/939
http://www.circulationaha.org/cgi/content/abstract/105/8/939
This study shows that coronary artery plaques with positive remodeling have a higher lipid content and macrophage count, both markers of plaque vulnerability. These results may explain why plaque rupture is often apparent at sites with only modest luminal stenoses (but marked positive remodeling).

In vivo temperature heterogeneity of atherosclerotic plaques is determined by plaque composition
Verheye S, et al.
Circulation 2002;105:1596-601.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11927529
http://www.circulationaha.org/cgi/content/full/105/13/1596
http://www.circulationaha.org/cgi/content/abstract/105/13/1596
In vivo temperature heterogeneity of rabbit atherosclerotic plaques is determined by plaque composition. In vivo thermography may have important clinical implications in the assessment of plaque composition.