Intravascular ultrasound assessment of arterial dissection, intimal flaps, and intraarterial thrombi

: Arterial dissection, intimal tears, and intraluminal thrombosis are common sequelae of catheter-based interventional procedures for coronary artery disease. These may not be recognized reliably by contrast angiography. Intravascular ultrasound imaging is an innovative method that allows visualization of the cross-sectional anatomy with high-resolution real-time images. This article presents the recent experience in arterial imaging with this method. Studies documenting the ability of intravascular ultrasound to demonstrate arterial atherosclerosis and to unmask some problems related to atherosclerotic disease and its treatment by catheter-based maneuvers are presented. Problems of arterial dissection, intimal flaps, and intravascular thrombosis are described with in vitro and in vivo documentation of the capability of intravascular ultrasound to visualize these abnormalities. The clinical implications of real-time imaging of intimal flaps and intraluminal clots, and the possible value of this imaging modality in the performance of catheter-based therapeutic procedures for coronary and peripheral arterial disorders are discussed.