Authors' objectives:

This report aims to assess the effectiveness of intravascular ultrasound (IVUS), the generic name for any ultrasound technology that is used in vivo within blood vessels.

Authors' results and conclusions: Diagnostic applications: IVUS appears to offer additional and complementary information over that provided by coronary angiography. It is able to more accurately demonstrate the likely extent of lesions in both coronary and peripheral vessels. It appears to have good sensitivity and specificity for detection of plaque dissections and media rupture, but lower sensitivity for the detection of plaque rupture and thrombus formation. It appears to have quite high accuracy in predicting the likely functional severity of lesions. IVUS can also provide information on the composition of plaques. There is some evidence to suggest that selected IVUS parameters may be able to predict clinical events. There is some evidence that IVUS alters management of patients with angiographically indeterminate or ambiguous lesions. In other patient groups, it is reasonable to assume that if IVUS can more accurately determine the extent of lesions, then the treating physician can choose more appropriate therapy. Therapeutic applications: Based on randomised controlled trial evidence, stent placement using IVUS guidance results in a statistically significant reduction in the odds of patients requiring target lesion revascularisation procedures at 912 months in the IVUS guided compared to non-IVUS guided treatment groups (Odds Ratio (OR) 0.73, 95% confidence interval 0.54 0.99, p=0.04). It should be noted that the upper limit of the 95% confidence interval is approaching the point of no effect (OR = 1). It is unclear at this stage whether the reduction in target lesion revascularisation is sustained over a longer follow-up period. It is also unclear whether it will result in improvements in either Q-wave myocardial infarction or in survival, as the trials were not powered to detect significant differences in either of these parameters.

Authors' recommendations: Since there is currently insufficient evidence pertaining to the effectiveness and cost-effectiveness of intravascular ultrasound as either a diagnostic or therapeutic tool, MSAC recommended that public funding should not be supported at this time for this procedure.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.msac.gov.au/reports.htm

Year Published: 2002

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Australia

Organisation Name: Medical Services Advisory Committee

Contact Address: MSAC (MDP 107), GPO Box 9848, Canberra, ACT 2601, Australia. Tel: +61 2 6289 6811; Fax: +61 2 6289 8799.

Contact Name: msac.secretariat@health.gov.au

Contact Email: msac.secretariat@health.gov.au

Copyright: Medical Services Advisory Committee (MSAC)