Intracoronary ultrasound indications during angioplasty procedures

Thanks to miniaturization and constant improvement of technologies, intraco ronary ultrasound (ICUS) progressively takes its place as the best tool to accurately analyze arterial wall structure. However, its routine use during interventional procedures remains limited. ICUS provides precious informat ions, complementary to angiography, and guide interventional procedures on the basis of a more accurate analyze of the components of the plaque, thus improving their success rate. Since its use favorized the understanding of the different devices mecanisms (angioplasty, stents, directional and rotat ional atherectomy), ICUS contributed to reduce the incidence of their compl ications. Many studies have emphasized ICUS interest during these procedures: their r esults seem to be significantly improved by the way of prompting the operat or to adopt an aggressive strategy (additional inflations using high pressu res, combination of different techniques...) which tend to reduce the compl ication rate and the restenosis incidence, Actually, the restenosis rate wa s in all these studies [OARS (29%), ABACAS (21%) and MUSIC (8.3%)] directly associated to ICUS parameters measured immediately after treatment, partic ularly the residual plaque burden. Whether its use, that engender substantial cost, cannot be systematic, trai ned centers will probably demonstrate that a rational and suitable use lead to adopt optimal strategies and achieve improved results.