Dr. Michael Lichtenberg and Dr. Konstantinos Stavroulakis define the four pillars of IVUS; vessel size, plaque morphology, plaque geometry, and guidewire position.
In order to be able to better understand that I was emerging, I would like to introduce you to the four pillars of rivals. The use of inter Luminal emerging can help us better assess the vessel and the Lumen diameter as well as the black burden. Also to access the Black Anthology to understand if we have to deal with the soft. If I brought it a calcified black to identify the presence of Trumbo's in treated, treated vessel. Additionally, it enables us to identify the plaque geometry. You have to do the deal with eccentric or co eccentric legion and finally, to understand our guide wire position most of the times when we can analyze a long city. Oh, it's not possible to identify our guide guide wire position Based on Lee on three Guide were passions. It's possible that sometimes when Truman Space, sometimes the seven month space and special long sitios most of the times you will be simultaneously both in the true movement and in the sub Endemol space. A major advantage Survivors is the use of chroma flaw, which identifies the red blood cell movement through the Lumen. This is very helpful in order to understand the Lumen size. As I said before the guide wire orientation the stent, opposition or mullah position. And of course, to better understand the black mythology, like the person's off dissections, thrombosis and plaque rupture as well as bifurcation or collaterals in the treatment segment, these air, some case examples how I wish can help us better understand the black morphology, as we see in this angiography who have a short, um, legion in the distal S f A and legal artery. And the according I was run can help us identify the black morphology. And of course, better under understand the other, like morphology. But which are the advantage of Ivers in this case, First of all, we can better assess the vessel size compared to an angiography. It is well known that angiography is, uh, imaging off the Lumen. Accordingly, we just see and were able to access on Lee the part of the part of the vessel which is patent. In this context, most of the times you will not be easy or a t least will be very difficult to understand the vessel size. Additionally, in this case, we can see that we have a fibra tick and soft black with eccentric geometry. And our guide wire is in the true. Lumen, Finally, we have no calcified disease and off course. This might be a short legion. Um, no, not a challenging one. But on the other hand, we can use Aibos. Um, toe better understand the plaque. Morphology better understand the underlying disease in more complicated legions. Like in this case, we have a challenging legion in the S f A. And as you see in the end, geography, we have an S f a occlusion with a long s if a lesion and these are tip collisions that you probably will need the use of intimate chick. In this case, we can also access the vessel size like in the previous one. We know that you have a broad material with eccentric plant morphology, and most interestingly, we see that our kite wire is in the Sabine Immel space. Despite despite the regionalization vessel, this might be very important. In order to guide your treatment, stretch some positions, avoid the use of vessel prep or aggressively bulking in cases off, submit Americanization, and this is something that we can only access with the use off intra Luminal image. Finally, a very important parameter that we have to keep in mind is the presence of calcium. In this case, we see no calcified disease, which can also be a very important parameter together strategy. We will create accordingly in a very different way calcified lesions and non calcified lesions. And I've us can better can help us better understand the president calcium it will have and media calcification. You have an internal calcification and so on in order to be able to effectively treat these lesions.