The first generations of intravascular ultrasound equipment consisted of a separate console that had to be wheeled out and booted up to use. The result was that the equipment very often sat on the sidelines.

However, today's IVUS can be integrated into the primary catheterization lab imaging console. For example, Volcano Corporation (Nasdaq: VOLC), one of only two U.S. manufacturers of IVUS systems, has partnered with all four major cath lab suppliers, GE, Philips, Siemens and Toshiba, and yesterday Volcano announced the 1,000th worldwide installation of its s5 and s5i integrated imaging consoles.

"I think the current generation IVUS integrated table side systems really streamline the process in terms of maintaining cath lab case and turnover efficiency, and frankly, their edge detection and imaging chain algorithms are becoming simpler to use, so that some of the historic barriers to being able to use IVUS efficiently and interpret the images and use that to possibly modify the intervention are improving.

"I think just the simple integration of IVUS systems at bedside is a huge benefit. It is tremendous! I think it’s something that just cannot be adequately captured -- this is incredibly beneficial. Because of that and the recurrent emphasis on having very good technique in stent deployment and device utilization, I think IVUS is going to have a resurgence."

Angioplasty.Org asked Dr. Shigeru Saito, the principal investigator of the Japanese studies for both clinical trials, why that might be. He replied simply, "IVUS -- in Japan IVUS is reimbursed so we use IVUS much more." Dr Saito, who is Director of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, explained how IVUS showed that sometimes the stent required further expansion:

"Before using IVUS, we were very happy just looking at the cine [angiography]. But after doing IVUS, we were not happy because the stent was not fully expanded.The most important thing about using IVUS is that we can exactly see whether the stent is fully expanded or not -- and the second thing: is the stent is fully apposed to the vessel wall? It's very important in terms of the long term stent thrombosis."

"If we use an integrated system, there really is no significant increase in the procedure time, and you’re not adding the personnel costs.... There’s no bringing in a machine, turning it on, waiting for the computer to boot up, and then a technician adding the name, the age, birth date, none of that has to be done....

"I would call it a plug-and-play environment, and you instantaneously have your pictures. In about one minute, I can get the IVUS set and do a pull-back into the artery that I'm interested in. And, of course, I’m looking at the images as I'm pulling back, and I'll usually spend another minute or two, on an interesting case, manipulating images, maybe making some measurements, and so forth. So from soup to nuts, we’re talking about three minutes to do IVUS."

"I don't care if you've got a balloon, a cutter, a zapper, a laser, whatever...whether you want to call the stent a XIENCE, or put it on a Vision, it doesn't make any difference. You still have to make sure that you've got a good opening, and the only way that you can do that effectively is with IVUS.

So, I don't care what they develop in the future -- we need a way to ensure that we have mechanically opened that vessel in the best way possible, and it depends on the plaque distribution, the plaque burden, the plaque calcification, etc., and the only way you can reliably look at that is with intravascular ultrasound.