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Intravascular Ultrasound
For many years the only way of directly viewing the coronary arteries was through angiography, or catheterization. With the invention and refinement of intravascular coronary ultrasound (IVUS) it is now possible to thread a tiny ultrasound "camera" into the coronary arteries to give a valuable cross-sectional view from the inside-out, showing the physician where the normal artery wall ends and the plaque begins.
intravascular ultrasound image
intravascular ultrasound image,
courtesy Volcano Corporation
While not a routinely used device -- like all catheter-based procedures, it is invasive, and there are costs associated with it -- in certain situations, IVUS can aid in the selection and sizing of stents and balloons, and can offer assurance that a stent has been properly deployed. This is of increasing importance in the era of drug-eluting stents. Research conducted using IVUS has also shown that one of the causes of restenosis may be inadequate dilatation -- that physicians, concerned with injuring or dissecting the artery itself, have tended to undersize the balloons.

The Future
These and other new devices are being developed continually and the information gathered through the use of catheter-based interventions may ultimately reveal the true mechanism of plaque formation. As this knowledge is applied in the field of molecular biology, promising new research and drug therapies may provide a way to prevent restenosis and plaque formation from occurring and yield an answer for conquering coronary artery disease.



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