What is an intravascular ultrasound?

An intravascular ultrasound is a minor procedure to diagnose and treat coronary artery disease. It is a catheter-based procedure that helps your doctor see how much your arteries have narrowed or thickened. Your doctor uses a very small ultrasound transducer on the catheter tip that makes images of the inside of your blood vessels and their walls. Doctors often use intravascular ultrasound during other cardiac catheterization procedures.

An intravascular ultrasound is only one method used to diagnose and treat coronary artery disease. Discuss all of your options with your doctor to understand which options are right for you. 

Other procedures that may be performed

Your doctor may perform other procedures in addition to an intravascular ultrasound. These include:

  • Angioplasty, including balloon and laser catheter procedures to open a coronary artery
  • Atherectomy, which involves drilling or scraping away plaques to open a coronary artery
  • Brachytherapy, which involves delivering radiation to a coronary artery through a catheter to treat or prevent restenosis. Restenosis is recurrence of coronary artery narrowing after stenting.
  • Stenting, which involves inserting a mesh tube inside your coronary artery and expanding it to keep the artery open after angioplasty. Stents remain in place to keep your coronary artery open.

Why is an intravascular ultrasound performed? 

Your doctor may recommend an intravascular ultrasound to diagnose or treat coronary artery disease. An intravascular ultrasound can provide more detailed images of the inside of your arteries than other coronary imaging methods, including angiography. Unlike angiography, an intravascular ultrasound can look at a cross-section of the artery wall and examine the layers of tissue in the artery wall.

An intravascular ultrasound is not a routine diagnostic or treatment tool. Your doctor may recommend an intravascular ultrasound for the following situations: 

  • Cardiac catheter procedures, to decide if treatment is necessary, guide the placement of devices, and assess treatment results 
  • Coronary artery disease, to evaluate coronary vessels when angiography is not helpful
  • Post-cardiac transplant, to examine coronary blood vessels and detect coronary disease that is often silent in these patients

Who performs an intravascular ultrasound?

Interventional cardiologists perform intravascular ultrasounds. An interventional cardiologist specializes in diagnosing and treating conditions and diseases of the heart and blood vessels. They use nonsurgical, catheter-based procedures and specialized imaging techniques.

How is an intravascular ultrasound performed?

Your intravascular ultrasound will be performed in a cardiac catheterization laboratory or cath lab for short. The procedure takes anywhere from less than an hour to several hours, depending on your condition. It generally includes these steps:

  1. You will dress in a patient gown and lie on a procedure table.
  2. You may have an IV (intravenous) line so the team can give you a sedative. The sedative will help you relax. 
  3. Your team will clean and shave an area on your groin or possibly your elbow. They will cover the area with sterile drapes. 
  4. Your team will place painless electrodes on your chest and attach them to an EKG (electrocardiogram) machine.
  5. Your doctor will use a local anesthetic to numb your groin.
  6. Your doctor will make an incision in your groin and insert and guide the catheter and ultrasound wire to your coronary arteries.
  7. Your doctor will take ultrasound pictures of your arties once the catheter is in place.
  8. Your doctor will remove the catheter and your team will remove the electrodes and your IV line.
  9. You will need to lie flat for up to six hours after the procedure.

Will I feel pain?

Your comfort and relaxation is important to both you and your care team. You may feel a pinch and brief stinging during the IV insertion and local anesthetic injection. You may also feel pressure during the incision, but you should not feel pain during the procedure. You will have enough pain and sedative medications so you stay comfortable. Tell your doctor or a member of your healthcare team if you feel chest discomfort or other symptoms during the procedure.