Intravascular ultrasound imaging of coarctation of the aorta: Animal and human studies

Although the use of balloon dilation for treatment of native and recurrent coarctation of the aorta (CoA) has become widespread, the optimal balloon size and postdilation vessel wall changes remain undetermined. Intravascular ultrasound (IVUS) imaging has emerged as an important adjunct in the treatment and follow-up of patients with coronary artery and peripheral vascular lesions, and has been used for evaluation in a limited number of patients with CoA. We used a combination balloon dilation/ultrasound imaging cath eter in animals with experimentally-induced CoA. This technique provided real-time data regarding aortic wall morphology and luminal diameter during balloon angioplasty of the CoA. In humans, we used IVUS to study CoA before and after both transcatheter and surgical therapy. IVUS was more sensitive than angiography in the detection of intimal tears post-balloon dilation and in the evaluation of vessel wall changes and remodeling observed at follow up after relief of CoA. IVUS may provide valuable information regarding vascular wall changes that predict an eurysm formation, restenosis, or a successful result after balloon dilation.