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Intravascular Ultrasound (IVUS)

Intravascular ultrasound (IVUS) is a special technique used along with percutaneous coronary intervention for complex coronary artery disease. This technology overcomes a number of limitations of nuclear imaging of blood vessels by taking pictures within the blood vessels and creating a cross-section with a 360-degree perspective to form a three-dimensional structure.

Benefit
To examine abnormalities or the artery and the structures of the narrowed artery. Intravascular ultrasound allows the doctor to assess the amount of plaque, determine the location for the stent as well as the size required, and determine complications of the procedure. Intravascular ultrasound also plays an important role in determining why a stent fails, such as excessive blockage in the stent or narrowing of the stent. This allows for further treatment planning.
 
To allow for the most effective treatment, the patient’s health and disease must be assessed. The patient’s medical history is also important. The doctor will explain your medical condition, the reason for the procedure, and the risks and benefits of treatment. As this procedure is usually done with percutaneous coronary intervention, preparation for the procedure is the same as percutaneous coronary intervention.
  1. Before the procedure you will undergo a physical examination as well as several laboratory tests.
  2. Please let your medical team know if you have any allergies to medication, food, and other substances.
  3. Patients who take anticoagulants, such as aspirin, clopidogrel, prasugrel, etc., do not need to stop their medication, but those taking other blood thinners or certain diabetes medication, such as Metformin, will need to speak to the doctor for specific instructions.
  4. Fast for at least four hours before the procedure.
  5. Avoid drinking alcohol and smoking cigarettes for at least one week.
  6. On the day of the procedure, please bring all current medication with you to the hospital.
  7. The doctor may prescribe medication to help you relax and to prevent allergies to contrast.
The procedure is done using a sterile technique. You will be given an anticoagulant to prevent blood clots. Medications/fluids will be given through intravenous lines. A local anesthetic will be injected to numb the area of your body that is used (the groin, the wrist, or the inside of the elbow). The guidewire for the intravascular ultrasound will then be inserted at the chosen location. The ultrasound uses a frequency of 40 megahertz and the tip of the wire can travel into the coronary artery, clearly displaying images of small blood vessels. The wire can twist and turn according to the blood vessel and up into the desired location.
 
After the procedure, you will be taken to a recovery area for observation and monitoring. It is important to lie flat for several hours to avoid bleeding. If the procedure was done at the groin, pressure may be placed at the site to prevent bleeding. If the catheter was inserted through the wrist, after the procedure you will be able to get up. A bandage will be placed at the insertion site.

Depending on your condition, you will remain in the hospital for one or more days. Ask your health care team when you can shower, return to work, and resume other normal activities. Your puncture site will remain tender for a while. It may be slightly bruised and have a small bump. Your doctor will likely prescribe medications to prevent blood clots. It is important to follow your doctor’s instructions regarding the blood thinning medications.
 
 
Let your doctor know if you experience any symptoms such as:
  • Chest pain
  • Difficulty breathing
  • Sweating
  • Heart palpitations
  • Dizziness, fainting
Before the procedure
  1. You should plan to stay in Thailand for at least one week through the duration of your treatment.
  2. It is recommended that you stay in a hotel close to the hospital for convenience in traveling to the hospital before and after the procedure or from the day of the procedure to the day of your follow-up appointment.
After the procedure
  1. At your follow-up appointment you will undergo a physical examination and your wound will be checked. You will receive documentation regarding your surgery or procedure and all other relevant documentation for traveling.
  2. You will receive information about caring for yourself when you return home and be given the document “Recommendations for Going Home After Percutaneous Coronary Intervention.” Please read all information you are given carefully and follow your medical team’s instructions.
  3. When traveling by air, if you are seated in Economy Class, please choose an exit row or bulkhead seat for convenience in getting up and moving around every 15-30 minutes. Flex your ankles regularly to prevent deep vein thrombosis.
  4. Please take all medication prescribed by your doctor. Carry the appropriate dosage of mediation in your carry-on luggage when you travel as well as a few extra doses in case of an emergency. Carry the prescription for all your medication to avoid problems at the airport.
The success of this procedure depends on many factors, including the structure of your blood vessels. If you have any questions, please talk to your doctor before the procedure.
 
What if the procedure isn’t performed?
       Abnormalities within the narrowed/blocked blood vessel may not be discovered, preventing appropriate treatment.
 
Fractional flow reserve (FFR), which can check if the blood vessel is actually narrowed/blocked; assessing the severity of atherosclerosis.
 

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