Ivory Tower How Intravascular Ultrasound transforming heart care

Among the remarkable advances in cardiology, Intravascular Ultrasound (IVUS) has emerged as one of the most powerful tools reshaping the way heart blockages are diagnosed and treated.

Unlike traditional angiography, which only outlines blood flow, IVUS allows doctors to look inside artery walls, offering a detailed, real-time view of what is truly happening within. This internal perspective often reveals vital information that angiography alone cannot show — such as the exact diameter of the artery, the type and extent of plaque build-up and hidden calcium deposits that may complicate treatment.

Interventional Cardiologist Dr Raman Chawla of CareBest Hospital, Jalandhar, delves into how technology in modern cardiac care has become the doctor’s most trusted ally, and how seeing the heart from the inside through IVUS is transforming treatment.

Dr Chawla explained that IVUS works through a miniature ultrasound probe mounted at the tip of a thin catheter inserted into the coronary arteries through the wrist or groin. Once inside, the probe emits sound waves that reflect off arterial walls, creating a detailed 360-degree image. These cross-sectional views help cardiologists measure the artery’s dimensions precisely and assess the characteristics of the blockage. This data ensures that the chosen balloon or stent size is based not on estimation but on exact measurements.

He said the clinical advantages of IVUS-guided angioplasty are significant and well-established. It helps achieve optimal stent placement by confirming that the stent is fully expanded and appropriately fitted against the artery wall, reducing the chances of re-blockage or future complications. It also enhances procedural safety, particularly in complex or heavily calcified arteries, by helping doctors avoid vessel rupture or incomplete treatment. Multiple global studies consistently show that patients undergoing IVUS-guided angioplasty experience better long-term outcomes, lower rates of re-narrowing and improved survival.

From a patient’s perspective, IVUS marks a shift towards precision medicine, treatment tailored to individual anatomy and disease patterns. It leads to fewer complications, better results and greater confidence that their heart procedure is guided by the most advanced imaging available. For doctors, it offers deeper insight and a scientific edge in decision-making, enabling them to move beyond the limitations of two-dimensional imaging.

Dr Chawla noted, “IVUS has proven particularly beneficial in challenging scenarios such as left main coronary artery disease, chronic total occlusions and cases of recurrent narrowing after previous stenting. It is also a valuable diagnostic aid when angiographic findings are unclear or ambiguous. In essence, IVUS acts as the ‘eye inside the artery’, bringing transparency and accuracy to procedures where every millimetre matters.”

As cardiology evolves, IVUS is becoming a cornerstone of image-guided interventions. With the integration of artificial intelligence and next-generation co-registration techniques, doctors can now align IVUS images with angiograms in real time, creating a precise procedural roadmap. The result is safer, smarter and more successful treatment.

In the words of Dr Raman Chawla, who routinely uses the technology with decades of angioplasty experience: “Intravascular Ultrasound is not just about seeing the artery; it’s about understanding it deeply and treating it safely.” He added that this advanced facility is now available at CareBest Superspeciality Hospital, Jalandhar, a cardiac destination where cutting-edge heart care meets long-standing clinical expertise.