Download Intravascular Ultrasound Pocket Guide, Seventh Edition by Robert J. Russo PDF

By Robert J. Russo

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Extra resources for Intravascular Ultrasound Pocket Guide, Seventh Edition

Example text

Indd 33 Calcium After Rotablator™ IVUS imaging was performed after rotational atherectomy. 25-mm Rotablator™ burrs were used prior to adjunct balloon angioplasty. IVUS revealed a dual or “double barrel” lumen created by sequential passes of the Rotablator burrs. The “figure of eight” appearance of the lumen represents preferential, rather than concentric, calcium ablation. The Rotablator burr appears to avoid previously treated portions of the artery that have a smooth surface. 45 mm greater than the diameter of the largest burr used.

The vessel media can be easily identified at 2–3 o’clock. However, the media, and thus the true vessel size, cannot be identified due to calcium shadowing. Caution should be used in vessel sizing in this circumstance. In addition, this appearance of contiguous, dense, superficial calcium adjacent to a normal vessel predicts dissection at the junction after balloon angioplasty alone. indd 39 Heavy Calcium Moderate calcification was noted in the mid-portion of a medium-caliper LAD with an inconclusive lesion by angiography.

The calcified rim results in moderate beam attenuation (far-field shadowing) in the left lower quadrant. Within the lumen, layered upon the calcific rim between 5–9 o’clock, is an intermediate echodensity. In this clinical setting, the intraluminal pathology is most consistent with layered luminal thrombus. This finding resolved after the administration of a GP IIb/IIIa inhibitor. Calcium 37 1/15/10 3:02:23 PM Eccentric Superficial CALCIUM This patient with crescendo anginal symptoms underwent diagnostic coronary angiography with an inconclusive lesion within the LAD.

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