What Is the Diagnostic Accuracy of IVUS in Detecting ISA?
There are no studies addressing this issue. It is assumed that IVUS detects significant ISA, missing only minor cases. However, metallic stent struts are strong ultrasound reflectors, and excessive gain settings can exaggerate both reverberations and side lobes to obscure the gap between the struts and the vessel wall. In addition, thrombus formation and blood stasis can fill in this space, and IVUS thrombus detection is notoriously difficult. Documentation of ISA is enhanced by flushing saline or contrast from the guiding catheter to wash out static blood and/or to confirm the presence or absence of flow.
