OBJECTIVE: To compare the diagnostic value of intravascular ultrasound (IVUS) with angiography in patients with pulmonary embolism. DESIGN: Open, prospective clinical study. SETTING: Two university hospitals. PATIENTS: Angiography and IVUS were used in 11 patients (5 men) (mean (SD) age 50 (18) years) with acute pulmonary embolism. INTERVENTIONS: At a mean (SD) of 6 (4) hours after thrombolytic therapy with urokinase and full-dose heparin, all patients underwent pulmonary artery angiography. Then 3.5 F mechanical, 20 or 30 MHz IVUS catheters were advanced into the pulmonary circulation. MAIN OUTCOME MEASURES: The pulmonary circulation was studied by both methods to detect the presence of thrombus, and a modified Miller score (assessing perfusion defects only and not velocity of flow) was used to quantify the angiographic images. RESULTS: The modified Miller score was mean (SD) 7.4 (2.3) points. 168 pulmonary artery segments (diameter range 2-14 mm) were studied by angiography and IVUS. On angiography, seven segments showed complete obstruction and 49 partial obstruction; 112 were normal. Two distinct types of thrombus formation were found by IVUS. Type A thrombus only partly adhered to the wall but otherwise was mobile and type B predominantly adhered to the wall. IVUS confirmed all seven angiographically complete obstructions but missed three (6%) of the 49 partial occlusions. Forty (87%) of the remaining 46 segments had type A thrombus and six (13%) type B. IVUS indicated a thrombus in 38 (34%) of the 112 angiographically normal segments; 20 (53%) showed a type A pattern and 18 (47%) a type B pattern (P < 0.001). CONCLUSION: IVUS was more sensitive than angiography in detecting thrombus but the clinical impact of this finding is not clear as yet.
OBJECTIVE: To compare the diagnostic value of intravascular ultrasound (IVUS) with angiography in patients with pulmonary embolism. DESIGN: Open, prospective clinical study. SETTING: Two university hospitals. PATIENTS: Angiography and IVUS were used in 11 patients (5 men) (mean (SD) age 50 (18) years) with acute pulmonary embolism. INTERVENTIONS: At a mean (SD) of 6 (4) hours after thrombolytic therapy with urokinase and full-dose heparin, all patients underwent pulmonary artery angiography. Then 3.5 F mechanical, 20 or 30 MHz IVUS catheters were advanced into the pulmonary circulation. MAIN OUTCOME MEASURES: The pulmonary circulation was studied by both methods to detect the presence of thrombus, and a modified Miller score (assessing perfusion defects only and not velocity of flow) was used to quantify the angiographic images. RESULTS: The modified Miller score was mean (SD) 7.4 (2.3) points. 168 pulmonary artery segments (diameter range 2-14 mm) were studied by angiography and IVUS. On angiography, seven segments showed complete obstruction and 49 partial obstruction; 112 were normal. Two distinct types of thrombus formation were found by IVUS. Type A thrombus only partly adhered to the wall but otherwise was mobile and type B predominantly adhered to the wall. IVUS confirmed all seven angiographically complete obstructions but missed three (6%) of the 49 partial occlusions. Forty (87%) of the remaining 46 segments had type A thrombus and six (13%) type B. IVUS indicated a thrombus in 38 (34%) of the 112 angiographically normal segments; 20 (53%) showed a type A pattern and 18 (47%) a type B pattern (P < 0.001). CONCLUSION: IVUS was more sensitive than angiography in detecting thrombus but the clinical impact of this finding is not clear as yet.
Authors: J L Evans; K H Ng; M J Vonesh; B L Kramer; S N Meyers; T A Mills; B J Kane; W N Aldrich; Y T Jang; P G Yock Journal: Circulation Date: 1994-02 Impact factor: 29.690
Authors: N Wittlich; R Erbel; A Eichler; S Schuster; H Jakob; S Iversen; H Oelert; J Meyer Journal: J Am Soc Echocardiogr Date: 1992 Sep-Oct Impact factor: 5.251
Authors: J M Tobis; J Mallery; D Mahon; K Lehmann; P Zalesky; J Griffith; J Gessert; M Moriuchi; M McRae; M L Dwyer Journal: Circulation Date: 1991-03 Impact factor: 29.690