Blood flow assessment with intravascular ultrasound catheters: the ideal tool for simultaneous assessment of the coronary haemodynamics and vessel wall?

We present the potentials of a novel method of intracoronary flow visualization and quantification that is based on conventional intravascular ultrasound (IVUS) imaging catheters. The quantification of flow is obtained from analysis of the rate of decorrelation of digitized radiofrequency ultrasound echo signals. Flow information is superimposed on the IVUS image using a colour scale. Integration of the blood velocity components normal to the scan plane permits calculation of the volume flow. Validation using IVUS and electromagnetic (EM) flowmeter recordings were obtained in vivo from instrumented pigs. IVUS flow (IVUS(f)) compared favourably to EM flow (EM(f)): IVUS(f)=1.0 EM(f)+5.72 cc/min, r2=0.98. Clinical results for the first five patients investigated are reported. A Doppler wire was used to measure the flow in four coronary arteries and one renal artery in baseline and hyperaemia conditions. IVUS flow and derived coronary flow reserve (CFR) demonstrated a very good agreement with the data derived from the combination of quantitative angiography and velocity when measured with the Doppler wire (DOP(f)): IVUS(f)=1.01 DOP(f)-20 cc/min, r2=0.90 and IVUS(cfr)=1.03 DOP(cfr)-0.03, r2=0.93. This demonstrates that simultaneous morphological and physiological assessment of coronary or peripheral arteries with one IVUS catheter is feasible. This method should be very useful for the evaluation of intermediate coronary stenoses or the results of revascularization procedures.