By: Abdi Waluyo Hospital

Overview

What is Intravascular Ultrasound (IVUS)?

Intravascular Ultrasound (IVUS) is an advanced intravascular imaging technology that uses high-frequency ultrasound waves to produce detailed, real-time images from inside the coronary arteries. Unlike conventional coronary angiography, which shows only the outline (lumen) of the blood vessel, IVUS provides a comprehensive view of the artery wall, atherosclerotic plaque, calcium deposits, and the true size of the vessel.

This detailed information allows cardiologists to accurately assess the severity of coronary artery disease, determine the most appropriate treatment strategy, select the optimal stent size, and confirm that the stent has been fully expanded and properly positioned after implantation.

At RS Abdi Waluyo, IVUS is used during selected Percutaneous Coronary Intervention (PCI) procedures to improve diagnostic accuracy, guide treatment decisions, and optimize long-term clinical outcomes.

Why is Intravascular Ultrasound (IVUS) Performed?

Your cardiologist may recommend IVUS to:

Determine the severity of coronary artery narrowing.
Evaluate the composition of atherosclerotic plaque, including calcified lesions.
Measure the diameter and size of coronary arteries accurately before stent implantation.
Select the appropriate stent size and length.
Confirm optimal stent expansion and positioning after implantation.
Identify causes of stent failure, such as underexpansion, malapposition, or restenosis.
Evaluate complex coronary artery disease, including left main disease, bifurcation lesions, long lesions, and heavily calcified arteries.
Improve the precision, safety, and long-term success of coronary intervention.

Details of the Procedure

IVUS is performed during Coronary Angiography or Percutaneous Coronary Intervention (PCI) in the Cardiac Catheterization Laboratory (Cath Lab).

Before the procedure:

Your cardiologist will review your medical history and medications.
Blood tests, an electrocardiogram (ECG), and echocardiography may be performed.
Coronary angiography will identify the location of the coronary blockage.
You may be instructed to fast for several hours before the procedure.
Inform your doctor if you have allergies to contrast dye, iodine, or medications.
Certain medications may require temporary adjustment before the procedure.

IVUS generally adds only 10–20 minutes to the overall PCI procedure.

What Happens During the Procedure?

During the procedure:

Local anesthesia is administered to the wrist (radial artery) or groin (femoral artery).
A catheter is inserted and guided to the coronary arteries using real-time X-ray imaging.
A miniature IVUS catheter containing an ultrasound transducer is advanced into the coronary artery.
The ultrasound probe produces detailed cross-sectional images of the artery in real time.
Your cardiologist evaluates the vessel size, plaque characteristics, calcium distribution, and severity of narrowing.
If PCI is being performed, IVUS findings help determine the ideal stent size and treatment strategy.
After stent implantation, IVUS may be repeated to confirm complete stent expansion, proper apposition against the vessel wall, and adequate blood flow.

Throughout the procedure, your heart rhythm, blood pressure, oxygen level, and overall condition are continuously monitored.

What Should I Expect After the Procedure?

Because IVUS is performed as part of coronary angiography or PCI, recovery follows the primary procedure.

After the procedure:

You will be monitored in the recovery area for several hours.
Most patients can return home the same day or the following day, depending on their condition.
Your doctor will provide instructions regarding medications, activity, wound care, and follow-up appointments.
If a coronary stent has been implanted, you will receive antiplatelet medications to reduce the risk of blood clot formation.

Most patients can gradually resume normal daily activities within a few days.

What Are the Risks?

IVUS is considered a very safe diagnostic tool with a low risk of complications.

Potential risks include:

Bleeding or bruising at the catheter insertion site.
Minor injury to the coronary artery (rare).
Temporary heart rhythm disturbances.
Allergic reaction to the contrast dye used during angiography.
Heart attack, stroke, or other serious complications (very rare).

Your healthcare team carefully monitors you throughout the procedure to ensure your safety.

Results and Follow-Up

IVUS provides highly detailed information about:

Coronary artery diameter.
Severity of arterial narrowing.
Plaque composition and burden.
Distribution and extent of calcium.
Stent expansion and apposition.
Causes of restenosis or previous stent failure.

This information enables your cardiologist to optimize treatment, reduce complications, and improve long-term outcomes following PCI.

When Will I Know the Results?

Because IVUS images are obtained in real time, your cardiologist can usually explain the findings immediately after the procedure.

Your doctor will discuss:

The condition of your coronary arteries.
The severity of the blockage.
Plaque characteristics.
Whether stent implantation was successful.
Recommendations for ongoing treatment and follow-up.

If Abnormal Findings Are Detected, What Are the Next Steps?

If IVUS identifies significant disease or suboptimal stent results, your cardiologist may recommend:

Further balloon optimization using high-pressure balloon dilation.
Placement of an additional coronary stent, if necessary.
Intravascular Lithotripsy (IVL) for severely calcified lesions.
Optical Coherence Tomography (OCT) for additional intravascular assessment in selected cases.
Coronary Artery Bypass Graft (CABG) surgery if PCI is not the most appropriate treatment.
Medical therapy and lifestyle modification to reduce cardiovascular risk.

Treatment recommendations will be individualized based on your coronary anatomy, symptoms, and overall health.

When Should I Call My Doctor?

Contact your doctor immediately if you experience:

Chest pain that returns or worsens.
Shortness of breath.
Persistent bleeding or swelling at the catheter insertion site.
Fever.
Severe pain, numbness, or discoloration of the arm or leg used during the procedure.
Rapid or irregular heartbeat.
Any new or worsening symptoms.

Seek emergency medical attention immediately if you develop severe chest pain, difficulty breathing, fainting, or symptoms suggestive of a heart attack or stroke.

Why Choose RS Abdi Waluyo for Intravascular Ultrasound (IVUS)?

At RS Abdi Waluyo, Intravascular Ultrasound (IVUS) is an integral part of our advanced interventional cardiology program, enabling more precise diagnosis and image-guided coronary intervention.

Our IVUS service offers:

Advanced high-resolution IVUS technology for detailed evaluation of coronary artery disease from inside the vessel.
State-of-the-art Hybrid Catheterization Laboratory (Hybrid Cath Lab) equipped with advanced imaging systems to support complex coronary interventions.
Experienced interventional cardiologists specializing in image-guided PCI and the treatment of complex coronary artery disease.
Comprehensive intravascular imaging, integrating IVUS with other advanced technologies such as Optical Coherence Tomography (OCT), Fractional Flow Reserve (FFR), and Intravascular Lithotripsy (IVL) when clinically indicated.
A multidisciplinary Heart Team approach, involving interventional cardiologists, cardiac surgeons, cardiac imaging specialists, and anesthesiologists to provide individualized treatment for complex cases.
Comprehensive cardiac care, from diagnosis and intervention to cardiac rehabilitation and long-term follow-up.
Patient-centered care, focused on improving procedural precision, enhancing long-term stent performance, and achieving the best possible cardiovascular outcomes.

By combining advanced intravascular imaging, expert clinical care, and Hybrid Cath Lab technology, RS Abdi Waluyo delivers world-class image-guided coronary intervention, helping ensure safer procedures, more accurate treatment decisions, and improved long-term outcomes for patients with coronary artery disease.