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Review
. 2024 Jan;39(1):1-14.
doi: 10.1007/s12928-023-00957-4. Epub 2023 Sep 1.

CVIT 2023 clinical expert consensus document on intravascular ultrasound

Yuichi Saito  1 , Yoshio Kobayashi  2 , Kenichi Fujii  3 , Shinjo Sonoda  4 , Kenichi Tsujita  5 , Kiyoshi Hibi  6 , Yoshihiro Morino  7 , Hiroyuki Okura  8 , Yuji Ikari  9 , Ken Kozuma  10 , Junko Honye  11
Affiliations
Review

CVIT 2023 clinical expert consensus document on intravascular ultrasound

Yuichi Saito et al. Cardiovasc Interv Ther. 2024 Jan.

Abstract

Intravascular ultrasound (IVUS) provides precise anatomic information in coronary arteries including quantitative measurements and morphological assessment. To standardize the IVUS analysis in the current era, this updated expert consensus document summarizes the methods of measurements and assessment of IVUS images and the clinical evidence of IVUS use in percutaneous coronary intervention.

Keywords: Coronary artery disease; Definition; Intravascular ultrasound; Measurement.

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Conflict of interest statement

Yoshio Kobayashi reports research grants from Abbott Medical Japan, Boston Scientific, Nipro and Terumo. Shinjo Sonoda reports speaker fees from Boston Scientific and Terumo. Kenichi Tsujita reports remuneration for lecture and scholarship fund from Abbott Medical Japan and affiliation with endowed departments from Boston Scientific Japan, Nipro, Terumo, and Abbott Medical Japan. Kiyoshi Hibi reports speaker fees from Boston Scientific, Nipro and Terumo. Yoshihiro Morino reports research grants from Abbott Medical Japan, Boston Scientific and Terumo. Hiroyuki Okura reports research grants from Abbott Medical Japan, Boston Scientific and Terumo. Yuji Ikari reports research grants from Boston Scientific, advisory grants from Abbott Medical Japanand Nipro, and royalties from Terumo. Junko Honye reports speaker fees from Abbott Medical Japan, Boston Scientific, Nipro and Terumo. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

Fig. 1
Fig. 1
Three layers of coronary arteries on intravascular ultrasound. Coronary arteries consist of three layers (“i”‐intima, “m”‐media, “a”‐adventitia). The innermost layer, tunica intima, comprises of three elements: endothelium (corresponding to the lumen surface), atheroma (if the arteries are diseased), and internal elastic membrane (IEM). The second layer is tunica media, which consists of smooth muscle and external elastic membrane (EEM). The third and outer layer is tunica externa, which comprises the adventitia and periadventitial tissues. A Normal coronary artery. B Diseased vessel. Asterisk indicates intravascular ultrasound catheter, and arrowhead indicates guidewire with acoustic shadow
Fig. 2
Fig. 2
Lumen, external elastic membrane (EEM), and plaque area measurements. A Coronary cross-sectional image with atheromatous plaque. B Lumen area is measured by tracing the leading edge of the intima. C EEM area is measured by tracing the border between the media and the adventitia. D Plaque area is calculated by (EEM area)−(lumen area)
Fig. 3
Fig. 3
Stent and calcium assessment. A Stent area is measured by tracing the leading edge of the stent strut. B Incomplete stent apposition (malapposition). Blood flow between struts and the underlying wall is observed (asterisk). C Calcium appears as bright echoes with acoustic shadowing, which may also produce reverberations or multiple reflections
Fig. 4
Fig. 4
Representative images of soft (lipid), fibrous, and mixed plaque. A Soft (lipid) plaque has low echogenicity in contrast to the reference adventitia. B Fibrous plaque has an intermediate echogenicity between soft (hypoechoic) plaque and highly echogenic calcified plaques. C Mixed plaque contains more than one subtype
Fig. 5
Fig. 5
Examples of qualitative measurements. A Attenuated plaque is accompanied by backward signal attenuation without dense calcium (circular arc). B Thrombus is usually observed as an intraluminal mass, often with a layered, lobulated, or pedunculated appearance (arrows). C Dissection with mobile flap (arrowheads). D Tissue protrusion is detected as tissue extrusion from stent or scaffold (asterisk). E True lumen (“t” in image) is surrounded by all three layers of the vessel wall, whereas false lumen (“f” in image) is not
See this image and copyright information in PMC

References

    1. Saito Y, Kobayashi Y, Fujii K, Sonoda S, Tsujita K, Hibi K, et al. Clinical expert consensus document on standards for measurements and assessment of intravascular ultrasound from the Japanese Association of Cardiovascular Intervention and Therapeutics. Cardiovasc Interv Ther. 2020;35:1–12. doi: 10.1007/s12928-019-00625-6. - DOI - PubMed
    1. Saito Y, Kobayashi Y, Fujii K, Sonoda S, Tsujita K, Hibi K, et al. Clinical expert consensus document on intravascular ultrasound from the Japanese Association of Cardiovascular Intervention and Therapeutics (2021) Cardiovasc Interv Ther. 2022;37:40–51. doi: 10.1007/s12928-021-00824-0. - DOI - PMC - PubMed
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    1. Mintz GS, Nissen SE, Anderson WD, Bailey SR, Erbel R, Fitzgerald PJ, et al. American College of Cardiology Clinical Expert Consensus Document on standards for acquisition, measurement and reporting of Intravascular Ultrasound Studies (IVUS). a report of the American college of cardiology task force on clinical expert consensus documents. J Am Coll Cardiol. 2001;37:1478–1492. doi: 10.1016/S0735-1097(01)01175-5. - DOI - PubMed

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