Intravascular Ultrasound


Sarah Lewis, PharmD

What is an intravascular ultrasound?

An intravascular ultrasound is a minor procedure used to diagnose and treat coronary artery disease. It is a catheter-based procedure that helps your doctor see how much your arteries have narrowed or thickened. Your doctor uses a very small ultrasound transducer on the catheter tip that makes images of the inside of your blood vessels and their walls. Doctors often use intravascular ultrasound during other cardiac catheterization procedures.

An intravascular ultrasound is only one method used to diagnose and treat coronary artery disease. Discuss all of your options with your doctor to understand which options are right for you. 

Other procedures that may be performed

Your doctor may perform other procedures in addition to an intravascular ultrasound. These include:

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  • Angioplasty, including balloon and laser catheter procedures to open a coronary artery

  • Atherectomy, which involves drilling or scraping away plaques to open a coronary artery

  • Brachytherapy, which involves delivering radiation to a coronary artery through a catheter to treat or prevent restenosis. Restenosis is recurrence of coronary artery narrowing after stenting.

  • Stenting, which involves inserting a mesh tube inside your coronary artery and expanding it to keep the artery open after angioplasty. Stents remain in place to keep your coronary artery open.

Why is an intravascular ultrasound performed? 

Your doctor may recommend an intravascular ultrasound to diagnose or treat coronary artery disease. An intravascular ultrasound can provide more detailed images of the inside of your arteries than other coronary imaging methods, including angiography. Unlike angiography, an intravascular ultrasound can look at a cross-section of the artery wall and examine the layers of tissue in the artery wall.

An intravascular ultrasound is not a routine diagnostic or treatment tool. Your doctor may recommend an intravascular ultrasound for the following situations: 

  • Cardiac catheter procedures, to decide if treatment is necessary, guide the placement of devices, and assess treatment results

  • Coronary artery disease, to evaluate coronary vessels when angiography is not helpful

  • Post-cardiac transplant, to examine coronary blood vessels and detect coronary disease that is often silent in these patients

Who performs an intravascular ultrasound?

Interventional cardiologists perform intravascular ultrasounds. An interventional cardiologist specializes in diagnosing and treating conditions and diseases of the heart and blood vessels. They use nonsurgical, catheter-based procedures and specialized imaging techniques.

How is an intravascular ultrasound performed?

Your intravascular ultrasound will be performed in a cardiac catheterization laboratory or cath lab for short. The procedure takes anywhere from less than an hour to several hours, depending on your condition. It generally includes these steps:

  1. You will dress in a patient gown and lie on a procedure table.

  2. You may have an IV (intravenous) line so the team can give you a sedative. The sedative will help you relax.

  3. Your team will clean and shave an area on your groin or possibly your elbow. They will cover the area with sterile drapes.

  4. Your team will place painless electrodes on your chest and attach them to an EKG (electrocardiogram) machine.

  5. Your doctor will use a local anesthetic to numb your groin.

  6. Your doctor will make an incision in your groin and insert and guide the catheter and ultrasound wire to your coronary arteries.

  7. Your doctor will take ultrasound pictures of your arties once the catheter is in place.

  8. Your doctor will remove the catheter and your team will remove the electrodes and your IV line.

  9. You will need to lie flat for up to six hours after the procedure.

Will I feel pain?

Your comfort and relaxation is important to both you and your care team. You may feel a pinch and brief stinging during the IV insertion and local anesthetic injection. You may also feel pressure during the incision, but you should not feel pain during the procedure. You will have enough pain and sedative medications so you stay comfortable. Tell your doctor or a member of your healthcare team if you feel chest discomfort or other symptoms during the procedure.

What are the risks and potential complications of an intravascular ultrasound?  

Complications after an intravascular ultrasound are not common, but any medical procedure involves risk and potential complications. Complications may become serious in some cases. Complications can develop during the procedure or your recovery. Risks and potential complications of an intravascular ultrasound include: 

Adverse reaction or problems related to sedation or medications, such as an allergic reaction and problems with breathing 

  • Bleeding

  • Blood clot

  • Damage to blood vessels

  • Heart attack

  • Infection

  • Soreness or discomfort of the groin or elbow site

  • Stroke

Reducing your risk of complications

You can reduce the risk of certain complications by following your treatment plan and:

  • Following activity, dietary and lifestyle restrictions and recommendations before your procedure and during recovery

  • Informing your doctor if you are nursing or there is any possibility that you may be pregnant

  • Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage 

  • Taking your medications exactly as directed

  • Telling all members of your care team if you have any allergies

How do I prepare for my intravascular ultrasound? 

You are an important member of your own healthcare team. The steps you take before your procedure can improve your comfort and outcome. You can prepare for an intravascular ultrasound by:

  • Answering all questions about your medical history, allergies, and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.

  • Arranging for a ride home after your procedure. It is also a good idea to have someone stay with you for the first 24 hours.

  • Getting pre-procedure testing as directed. Testing may include a chest X-ray, EKG (electrocardiogram), and blood tests.

  • Not eating or drinking before your procedure as directed. Your doctor will give you specific instructions.

  • Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and can help the healing process.

  • Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners. Your doctor will give you instructions for taking your specific medications and supplements.

Questions to ask your doctor

Preparing for an intravascular ultrasound can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before your procedure.

It is also a good idea to bring a list of questions to your appointments. Questions can include:

  • Why do I need an intravascular ultrasound? Are there any other options for diagnosing or treating my condition?

  • If you find a problem, will you treat it right away or will I need another procedure later?

  • How long will the procedure take? When can I go home?

  • What restrictions will I have after the procedure? When can I return to work and other activities?

  • What kind of assistance will I need at home? Will I need a ride home?

  • What medications will I need before and after the procedure? How should I take my medications?

  • How will you treat my pain?

  • When should I follow up with you? 

  • When and how will I receive the results of my procedure?

  • How should I contact you? Ask for numbers to call during and after regular hours.

What can I expect after my intravascular ultrasound?

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