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Review
. 2025 Apr;105(5):1171-1182.
doi: 10.1002/ccd.31433. Epub 2025 Feb 3.

The Role of IVUS in Coronary Complications

Fabrizio Ugo  1 , Marco Franzino  1 , Gianluca Massaro  2 , Ludovica Maltese  1 , Chiara Cavallino  1 , Mohamed Abdirashid  1 , Daniela Benedetto  2 , Francesco Costa  3   4   5 , Francesco Rametta  1 , Giuseppe Massimo Sangiorgi  2   6
Affiliations
Review

The Role of IVUS in Coronary Complications

Fabrizio Ugo et al. Catheter Cardiovasc Interv. 2025 Apr.

Abstract

Intravascular ultrasound (IVUS) is an essential tool in the diagnostic and therapeutic management of coronary artery disease. In daily practice, IVUS is particularly useful for plaque characterization, optimizing stent implantation, and identifying the cause of in-stent restenosis. In acute coronary syndromes, it helps to detect culprit lesions that are not clearly visible on angiography and plays a key role in the diagnostic algorithm for myocardial infarction with non-obstructive coronary arteries (MINOCA). Additionally, IVUS is frequently used in complex and calcified lesions to guide optimal plaque modification strategies and improve procedural and long term outcomes. Beyond these common applications, IVUS is crucial in managing coronary complications, such as coronary dissection, perforation, intramural hematoma, and side-branch occlusion. In these challenging cases, IVUS allows us to overcome some of the limitations of angiography. This review explores the role of IVUS in bail out situations, offering practical tips and techniques for navigating coronary complications and improving procedural success in a safer and more refined manner.

Keywords: IVUS; PCI; coronary complication; coronary dissection; coronary occlusion; coronary perforation; intracoronary imaging.

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References

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