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Intravascular ultrasound (IVUS) is an intravascular imaging modality primarily used in interventional cardiology to characterize lesion morphology, quantify plaque burden, guide stent sizing, assess stent expansion, and identify procedural complications. This activity reviews the role of IVUS and its indications and highlights the role of the interprofessional team in the management of patients with coronary artery disease. Objectives: Identify the technique for performing intravenous ultrasound. Describe the indications for intravenous ultrasound. Explain the clinical utility of intravenous ultrasound. Employ interprofessional team strategies for improving care coordination and communication to advance the diagnosis of coronary artery disease using intravenous ultrasound. Access free multiple choice questions on this topic.

Intravascular ultrasound (IVUS) is an intravascular imaging modality primarily used in interventional cardiology to characterize lesion morphology, quantify plaque burden, guide stent sizing, assess stent expansion, and identify procedural complications.[1]  Using a dedicated catheter with ultrasound-based technology an image is obtainable from inside an artery producing cross-sectional images with a 360-degree view of the vessel. This technology overcomes many of the limitations of angiography, which utilizes x-ray technology to produce a 2-dimensional lumenogram of a 3-dimensional structure. Rather than assessing the vessel from the outside as with angiography, IVUS provides the assessment from within the vessel.

Complications due to IVUS use are uncommon but may include dissection, perforation, arrhythmia, thrombosis, and vasospasm as can occur during any instrumentation of a coronary vessel.[7] Particular care is necessary for highly tortuous vessels.

IVUS is an important adjunctive tool in the cardiac catheterization laboratory that can be useful to determine plaque morphology and guide percutaneous coronary interventions.  Image interpretation is an important skill with IVUS use to optimize clinical outcomes. The use of IVUS has been associated with improved clinical outcomes in both an all-comers population and those with long lesions undergoing stent implantation (28 mm stent implanted).[9][10][Level I] To provide the best outcome, interprofessional team involvement is necessary. The nurse needs to be well aware of the procedure and complications and assist the interventional cardiologist or vascular surgeon as they manipulate the catheter inside of the body. Prior to the procedure, the nurse should assist with pre-operative screen for allergies or injuries that may hinder the performance of the procedure. If there is a concern, the should report back to the clinician. Often the nurse will need to assist with position and preparation of the patient. The nurse should also monitor vital signs and the ECG during the procedure and should alert the surgeon if there are changes in vitals signs or an untoward change in the cardiac monitor. Always quickly reporting to the surgeon if there is a concern. Post-procedure the nurse must monitor for signs of bleeding or infection. Again, quickly informing the surgeon if there is a concern. The best outcomes will be achieved if an interprofessional approach is taken in regards to the performance of this procedure. [Level V] [15]