Intravascular Ultrasound (IVUS) is an essential intracoronary imaging modality that provides real-time, cross-sectional visualization of coronary anatomy for precise lesion assessment and PCI optimization. This session provides a full-spectrum review of IVUS technology, interpretation, and clinical integration. As imaging-guided PCI becomes standard, many clinicians turn to an cardiology conference to deepen their understanding—precisely the level of practical depth reflected in this session, enhanced by advanced IVUS interpretation strategies for complex lesions.

The description begins by explaining how IVUS works—ultrasound waves emitted from a miniaturized catheter generate high-resolution images of lumen dimensions, vessel size, plaque morphology, and stent position. Participants will understand the advantages of IVUS over angiography alone, including improved accuracy in stent sizing, plaque characterization, and identification of complications such as edge dissections or under-expansion.

Key imaging concepts are covered in detail: MLA (minimum lumen area), EEL-to-EEL measurement, vessel remodeling index, plaque burden, calcification depth, lipid pools, thrombus detection, and stent optimization markers such as expansion, apposition, and symmetrical deployment. Real-world images are described to help participants differentiate normal, intermediate, and high-risk features.

The session emphasizes how IVUS guides lesion preparation—from balloon sizing to atherectomy—especially in heavily calcified or fibrotic lesions. Participants will learn how IVUS shifts decision-making in bifurcation PCI, left-main stenting, ostial lesions, and long diffuse disease. Algorithms for stent sizing, selection, and post-dilation are outlined clearly, allowing clinicians to make evidence-based choices.

Case-based interpretations illustrate how IVUS prevents adverse outcomes such as restenosis and stent thrombosis by identifying mechanical issues before they lead to complications. Participants will also explore the integration of IVUS with physiology (IFR/FFR) and angiographic co-registration for comprehensive lesion guidance.

The session highlights applications beyond coronary arteries, including peripheral interventions, structural heart procedures, and device optimization. Troubleshooting topics cover artifact recognition, image quality improvement, wire bias, catheter positioning challenges, and interpretation pitfalls.

Future directions include AI-assisted IVUS reconstruction, 3D vessel modeling, automated stent expansion scoring, and fusion imaging combining IVUS with OCT or CT. The session also reviews major clinical trials demonstrating improved outcomes with IVUS-guided PCI, providing the evidence foundation required to incorporate imaging routinely into practice.

Participants will receive structured interpretation templates and stent optimization checklists that help standardize IVUS use in catheter labs. This ensures consistent, high-level imaging support across physicians and centers.