Cardiology · Intravascular Imaging

Intravascular Imaging (OCT & IVUS)

Treating what the eye can see — from inside the artery

Medically reviewed by Dr Kunal Ajay Patankar, DrNB (Cardiology)

What it is

Angiography shows an artery's silhouette; intravascular imaging shows its anatomy. A miniature camera or ultrasound probe travels inside the artery, revealing plaque type, calcium, true vessel size and stent expansion in microscopic detail.

OCT (Optical Coherence Tomography) uses light for near-histology resolution; IVUS (Intravascular Ultrasound) uses sound and sees deeper into the wall. Imaging-guided angioplasty is consistently associated with better outcomes than angiography alone — it is central to how I practise.

Who needs it

  • Complex or calcified lesions before angioplasty
  • Left main artery disease, where precision is critical
  • Uncertain lesion severity or vessel size on angiography
  • Suspected stent failure — restenosis or thrombosis
  • Optimising stent results in high-risk patients

How it happens, step by step

1

Probe insertion

During angioplasty, the imaging catheter is advanced over the same wire — adding only minutes to the procedure.

2

Automated pullback

The probe records a continuous cross-sectional film of the artery as it is drawn back — like an MRI of the vessel from within.

3

Measurement & planning

Vessel diameter, lesion length and calcium are measured exactly, dictating balloon and stent size — no guesswork.

4

Post-stent check

A final run confirms the stent is fully expanded and well apposed — the strongest predictor of long-term stent success.

Recovery, honestly

  • No additional recovery beyond the angioplasty itself
  • No separate incision — same wrist access
  • Adds a small amount of time but significant long-term benefit

Common questions

Does imaging make the procedure riskier?+

No — it is very safe in experienced hands and typically reduces overall risk by preventing under-expanded or wrongly sized stents.

OCT or IVUS — which will you use?+

OCT excels at fine detail and stent optimisation; IVUS penetrates deeper and suits large or kidney-sensitive cases since it needs less contrast dye. The lesion decides.

Is it always necessary?+

Not always. For simple lesions, angiography may suffice. For complex, calcified or left main disease, imaging measurably improves outcomes and I use it routinely.

Wondering if Intravascular Imaging is right for you?

Every heart is different. Bring your reports and questions — we'll map your options together.