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Cardiologists use of tools such as IVUS, FFR etc for angiograms or PCI?

Everything I've read about IVUS (intra vascular ultrasound) and FFR (Fractional Flow Reserve) and newer imaging tools to examine and quantify coronary arteries says that they improve outcomes in stents.   It allows the cardiologist to better view the interior of arteries, plaque or calcium configuration, and enables them to do a more precise diagnosis, placement and expansion of stents.  FFR also allows them to better quantify blockages by measuring pressure drop across a lesion.   I've had three stent procedures over the last 20 years and only the first one used IVUS.   Why don't more doctors use this?  Anything that provides better outcomes than the use of angiography only, most would want used on their procedures. Any thoughts on this?   I may face this again.  Thanks.  
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Avatar universal
Gotta love wikipedia:
Disadvantages versus angiography[edit]

The primary disadvantages of IVUS being used routinely in a cardiac catheterization laboratory are its expense, the increase in the time of the procedure, and the fact that it is considered an interventional procedure, and should only be performed by angiographers that are trained in interventional cardiology techniques. In addition, there may be additional risk imposed by the use of the IVUS catheter.

The computerized IVUS echocardiographic imaging systems list for $120,000, US, 2007 for a cart based system and ~$70,000 for an installed or integrated solution. The disposable catheters used to do each examination typically cost ~$600, US, 2007. In many hospitals, the IVUS system is placed as part of a bundle deal based on minimum disposable sales volumes. In other words, the cost of the console is paid for by rebates from other purchased products including IVUS catheters. Because no standard exists, IVUS catheters cannot be interchanged between different manufacturers.

Additionally, IVUS adds significant additional examination time and some increased risk to the patient beyond performing a standard diagnostic angiographic examination. This increase is significantly less when IVUS is part of a percutaneous coronary intervention, since much of the setup is the same for the intervention as for the IVUS imaging.

IVUS continues to improve and some manufacturers have proposed building IVUS technology into angioplasty and stent balloon catheters, a potential major advance, but limited by complexity, cost and increased bulk of the catheters.
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1 Comments
Thanks for the response.
11548417 tn?1506080564
Afaik, in the developed countries FFR is standard done during the angiographic procedure.
The outcome of the FFR measurements guides the cardiologist in the decision if the patient will benefit from a stent placement or not.

IVUS is not used standard. Some cardiologists use it occasionally, in difficult cases, or to assist in the selection and sizing of stents and balloons. Others use it routinely, to confirm accurate stent placement and optimal stent deployment.

I guess, in a couple of year it will be routinely used by all cardiologists/interventionalists. Now it is perhaps used only by the early adapters.

Although the IVUS tool can help in diagnosis and in treatment it will make the whole angiographic procedure take more time.
I can imagine that in straightforward cases, diagnosis is easy without IVUS. It then makes sense to stop the procedure asap without the use of IVUS.
Helpful - 0
11548417 tn?1506080564
Afaik, in the developed countries FFR is standard done during the angiographic procedure.
The outcome of the FFR measurements guides the cardiologist in the decision if the patient will benefit from a stent placement or not.

IVUS is not used standard. Some cardiologists use it occasionally, in difficult cases, or to assist in the selection and sizing of stents and balloons. Others use it routinely, to confirm accurate stent placement and optimal stent deployment.

I guess, in a couple of year it will be routinely used by all cardiologists/interventionalists. Now it is perhaps used only by the early adapters.

Although the IVUS tool can help in diagnosis and in treatment it will make the whole angiographic procedure take more time.
I can imagine that in straightforward cases, diagnosis is easy without IVUS. It then makes sense to stop the procedure asap without the use of IVUS.
Helpful - 0
2 Comments
Thanks for your insight.  

Speaking from the POV of a patient who has gone though 3 PCI procedures,   we want the procedure to be the most effective and result in as few complications as possible.  And even though it takes little additional time and costs another $600 etc,  most who were aware of advantages would want it.  You would think even insurance companies would prefer that option if it cuts complications by 50%.   Some patients might even pay for the option out of pocket given the chance.  

The first and only time IVUS was used in a PCI on me was 1995, and I was event free for 13 years.  I've had PCI done twice since w/o IVUS. I have had about 5 event free years from first and it is undetermined from the most recent PCI in 2013.
13 years event free, compared to 5 is of course impressing.

You can however not do statistics and draw solid conclusions from your few examples.
There can be so many extra factors playing much more important roles in the success of your PCI's than the use/not use of IVUS.

Still, I can too see many advantages of the use of IVUS.
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