Intravascular ultrasound (IVUS) uses a catheter-mounted ultrasound transducer to visualize the inside of blood vessels. The transducer emits high-frequency sound waves that bounce off vessel tissues and are converted into images. IVUS provides accurate measurements of vessel size and plaque buildup. It is used pre-and post-intervention to assess plaque and guide procedures like stenting. While it adds little risk, IVUS imaging may be limited in very narrow vessels. The detailed images aid clinical decisions regarding lesion assessment, stent selection and placement, and detection of complications.
IVUS may not be clinically warranted in all interventions, and should be seen as an adjunct to angiography. IVUS provides information about vessel morphology, plaque topography, and therapeutic outcomes that is often either equivocal or unavailable in angiographic images.
There are 3 situations in which IVUS has the most clinical utility:
Small vessel stenting: Studies have shown that post-stent restenosis rates are higher in small vessels. This is particularly true for vessels with diameters of 3.0mm or less, wherein small increases in stent diameter have been shown to significantly decrease the rate of restenosis. A study by Moussa et al showed that, as measured by IVUS, the incidence of restenosis has an inverse relationship to the post-procedure in-stent lumen CSA1.
In-Stent restenosis: In these cases, IVUS helps to determine whether the restenosis is due to inadequate stent deployment (underexpansion or incomplete apposition) due to intimal hyperplasia. IVUS will also help you select the proper device size for treatment of the stented area.
Difficult to assess lesions: At times, images of a lesion and the adjacent reference segment are often hazy. IVUS should be used to identify whether the angiographic appearance is due to dissection, thrombus, residual plaque, or is benign.
A detailed description of ct coronary angiography and calcium scoring with various aspects regarding the preparation, procedure, limitations and a short review regarding post CABG imaging.
IVUS may not be clinically warranted in all interventions, and should be seen as an adjunct to angiography. IVUS provides information about vessel morphology, plaque topography, and therapeutic outcomes that is often either equivocal or unavailable in angiographic images.
There are 3 situations in which IVUS has the most clinical utility:
Small vessel stenting: Studies have shown that post-stent restenosis rates are higher in small vessels. This is particularly true for vessels with diameters of 3.0mm or less, wherein small increases in stent diameter have been shown to significantly decrease the rate of restenosis. A study by Moussa et al showed that, as measured by IVUS, the incidence of restenosis has an inverse relationship to the post-procedure in-stent lumen CSA1.
In-Stent restenosis: In these cases, IVUS helps to determine whether the restenosis is due to inadequate stent deployment (underexpansion or incomplete apposition) due to intimal hyperplasia. IVUS will also help you select the proper device size for treatment of the stented area.
Difficult to assess lesions: At times, images of a lesion and the adjacent reference segment are often hazy. IVUS should be used to identify whether the angiographic appearance is due to dissection, thrombus, residual plaque, or is benign.
A detailed description of ct coronary angiography and calcium scoring with various aspects regarding the preparation, procedure, limitations and a short review regarding post CABG imaging.
Patients with peripheral arterial disease (PAD) and critical limb ischemia are at risk for limb amputation and require urgent management to restore blood flow. Patients with PAD often have several comorbidities, including chronic kidney disease, diabetes mellitus, and hypertension. Diagnostic and interventional angiography using iodinated contrast agents provides excellent image resolution but can be associated with contrast-induced nephropathy (CIN). The use of carbon dioxide (CO2) as a contrast agent reduces the volume of iodine contrast required for angiography and reduces the incidence of CIN. However, CO2 angiography has been underutilized due to concerns regarding safety and image quality. Modern CO2 delivery systems with advanced digital subtraction angiography techniques and hybrid angiography have improved imaging accuracy and reduced the incidence of CIN. Awareness of the need for optimal imaging conditions, contraindications, and potential complications have improved the safety of CO2 angiography. This review aims to highlight current technological advances in the delivery of CO2 in vascular angiography for patients with PAD and critical limb ischemia, which result in limb preservation while preventing kidney damage.
Diagnostic catheters for coronary angiography Aswin Rm
Overview of diagnostic catheters used in coronary angiography
Guide catheters not included
History of coronary catheters
Radial techniques and catheters
SELDINGER TECHNIQUE & INTERVENTIONAL RADIOLOGYRiyas M K
its a basic introduction about Seldinger technique and Intervetional radiology.In interventional radiology, procedures generally start with the Seldinger technique to access the vasculature, using a needle through which a guidewire is inserted, followed by navigation of catheters within the vessels.
Patients with peripheral arterial disease (PAD) and critical limb ischemia are at risk for limb amputation and require urgent management to restore blood flow. Patients with PAD often have several comorbidities, including chronic kidney disease, diabetes mellitus, and hypertension. Diagnostic and interventional angiography using iodinated contrast agents provides excellent image resolution but can be associated with contrast-induced nephropathy (CIN). The use of carbon dioxide (CO2) as a contrast agent reduces the volume of iodine contrast required for angiography and reduces the incidence of CIN. However, CO2 angiography has been underutilized due to concerns regarding safety and image quality. Modern CO2 delivery systems with advanced digital subtraction angiography techniques and hybrid angiography have improved imaging accuracy and reduced the incidence of CIN. Awareness of the need for optimal imaging conditions, contraindications, and potential complications have improved the safety of CO2 angiography. This review aims to highlight current technological advances in the delivery of CO2 in vascular angiography for patients with PAD and critical limb ischemia, which result in limb preservation while preventing kidney damage.
Diagnostic catheters for coronary angiography Aswin Rm
Overview of diagnostic catheters used in coronary angiography
Guide catheters not included
History of coronary catheters
Radial techniques and catheters
SELDINGER TECHNIQUE & INTERVENTIONAL RADIOLOGYRiyas M K
its a basic introduction about Seldinger technique and Intervetional radiology.In interventional radiology, procedures generally start with the Seldinger technique to access the vasculature, using a needle through which a guidewire is inserted, followed by navigation of catheters within the vessels.
Radiology procedures such as ultrasound, MRI or CT scans are very useful in detecting and diagnosing cardiovascular anomalies. Fluoroscopy is mostly used in cardiac intervention.
Coronary Balloon Angioplasty and Stents Procedure Information by We CareP Nagpal
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On November 10, a meeting about the role of IVUS on vascular surgery (Chairman Prof. Andrea Stella) took place in Bologna. The meeting was an excellent opportunity to discuss about the role of the IVUS in every field of vascular surgery: type B dissections, AAA's, PAOD, popliteal aneurysms and chronic venous obstructions.
Vertebral artery pseudo-aneurysms and dissections are known to occur as a result of mechanical
manipulations of the cervical region, traumatic injury, spontaneously and iatrogenic injury because of central
venous catheterization. Central venous lines have become an integral part of patient care, but they are
not without complications. Vertebral artery injury (leading to pseudo-aneurysm and dissection) is one of
the rarer complications of central venous catheter placement. We report a case of inadvertent vertebral
artery catheterization during a dialysis catheter placement which subsequently demonstrated arterial
blood. Duplex ultrasound and computed tomographic (CT) scan confirmed vertebral artery catheterization.
It was successfully treated with open surgical technique by the vascular surgeon because of the size of
catheter and subsequent requirement of artery repair. There were no neurological sequelae. Open surgical
repair remains the gold standard of treatment. Endovascular repair of vertebral artery pseudo-aneurysms
has been described with promising outcomes, but long-term results are lacking. This case report describes
the rare iatrogenic event of vertebral artery injury and reviews its etiology, diagnosis, complications, and management.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
2. Intravascular ultrasound (IVUS) is a medical imaging methodology using a
specially designed catheter with a miniaturized ultrasound probe attached to
the distal end of the catheter.
The proximal end of the catheter is attached to computerized ultrasound
equipment.
It allows the application of ultrasound technology to see from inside blood
vessels out through the surrounding blood column, visualizing the endothelium
(inner wall) of blood vessels in living individuals.
3. IVUS uses echocardiography : Very high frequency sound waves, called
ultrasound, are emitted by a transducer.
These ultrasound waves, which are beyond the range of human hearing,
bounce off the various types of tissue structures in the body and the echo of
these waves is then converted into a picture.
4. Physics and equipment
IVUS systems contain a special transducer mounted catheter and an electronics
console to reconstruct the image. The ultrasound signal is produced in the
transducer by passing an electrical current through the piezoelectric (pressure-
electric) crystalline material (usually ceramic) that expands and contracts when
electrically excited.
After reflection from tissue, part of the ultrasound energy returns to the
transducer and is converted into the image. High ultrasound frequencies (20–
40 MHz) are employed resulting in an axial resolution in the range of 80–
150 μm and lateral resolution of 200–250 μm.
5.
6.
7.
8.
9.
10. PRE-INTERVENTION
Accurate quantitation
Assessment of reference segment disease
Interventional strategy & device selection
In-stent restenosis
Plaque composition
Length of lesion
15. Contraindication for IVUS guidance,
small vessels,
tortuous vessels and
degenerated vein grafts.
16.
17. A very small skin incision is made at the site. A sheath is first inserted into an artery or vein
(usually in the groin). Using x-ray or ultrasound guidance, the catheter is inserted into the
sheath and gently maneuvered through the vessel to the target location over a very thin, soft
wire.
Once in place, the transducer on the end of the catheter uses sound waves to produce pictures
of the blood vessels.we can move the catheter to obtain images of the inside of the vessels at
different locations. At the end of the procedure, the catheter will be removed and pressure will
be applied to stop any bleeding. The opening in the skin is then covered with a dressing. No
sutures are needed.
18.
19.
20.
21.
22.
23. IVUS has many benefits including:
showing the presence and amount of plaque in arteries measuring the degree to which
the vessel has become narrowed from plaque
providing information about what the plaque is made of
detection of restenosis
more accurate stent placement and
reduced incidence of stent thrombosis in arteries and veins
finding stenosis or narrowing which is not well seen with angiography
finding areas of vein external compression, which may be predisposed to blood clots
no exposure to ionizing radiation
24. Any procedure that involves placement of a catheter inside a
blood vessel carries certain risks. These risks include
damage to the blood vessel, bruising or bleeding at the puncture site, and
infection. However precaution is taken to mitigate these risks.
Other risks may include:
irregular heart rhythms (arrhythmia)
a blood clot
an allergic reaction to the medications used during the procedure
very rare cases, a heart attack, stroke, or blood clot in the lung
IVUS itself adds little additional risk to angioplasty and catheter angiography
25. Because of the catheter's size and stiffness, IVUS sometimes cannot be
navigated through very narrowed or twisted blood vessels.
The technology sometimes produces image artifacts.
There is conflicting information regarding the ability of IVUS to characterize
high-risk plaques and thrombus.
26.
27.
28. How to determine lesion length morphology
How to identify dissections
Determining appropriate stent placement
Determining lesion size
Understanding the shortfalls of angiography
the adventitia -- the outer covering of the artery;
the media -- the actual wall of the artery;
the intima -- a layer of endothelial and other cells that make direct contact with the blood inside the artery -- in normal arteries this layer is thin; in diseased arteries (shown here) the intima is thickened by plaques or other tissue growth, often eccentric or asymmetrical;
the lumen -- the actual open channel of the artery through which the blood flows.
In angiography, angle of view determines what we see
As LMCA lesions are short, often calcified and diffuse involving the ostium or bifurcation, IVUS plays a pivotal role in assessing the significance of these lesions, which are notoriously difficult to accurately assess with angiography alone.
RATIO OF DISTAL MEAN CORONARY PR. TO MEAN AORTIC PRESSURE IN THE STENOTIC VESL DURING MAX. HYPEREMIA
REPRESENTS THE FRACTION OF BLOOD FLOW PRESERVED DESPITE STENOSIS .N:>0.8;SIGNIFICANT:<0.75
Because of the catheter's size and stiffness
The IVUS catheter is a thin, flexible tube with a tiny ultrasonic transducer attached to one end. The other end of the catheter connects to a computer workstation that converts the sound waves from the transducer into real-time images on a monitor. Different size catheters are available depending on the type of blood vessel being imaged.