Venous Interventions

Session: Educational Exhibit Presentations - Station 8: Neurointerventional Radiology and Nonvascular Interventions

Intracardiac Echocardiography (ICE) and Intravascular Ultrasound (IVUS): Two Powerful but Underutilized Tools which Expand the Role of Interventional Radiology Especially in Pericardiac/Intracardiac Interventions

Monday, March 6, 2023

5:25 PM – 5:30 PM

Location: Phoenix Convention Center, North Ballroom 120ABC, Poster Hall

Abstract Presenter(s)

MD

Mouhamed Diop, MD

Resident
University of Cincinnati

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

Lulu Zhang, MD

Assistant Professor of Radiology
University of Cincinnati Medical Center
Ali Kord, MD, MPH

Assistant Professor of Radiology
University of Cincinnati Medical Center

Disclosure(s):

Mouhamed Diop, MD: No financial relationships to disclose

Lulu Zhang, MD: No financial relationships to disclose

Ali Kord, MD, MPH: No financial relationships to disclose

Learning Objectives:

Review the utility of Intracardiac Echocardiography (ICE)/Intravascular Ultrasound (IVUS) in interventional radiology (IR) procedure

Demonstrate specific clinical situations where ICE or IVUS provides vital image guidance

Background: Intracardiac echocardiogram, an expansion of intravascular ultrasound, is a powerful, but often underutilized tool in the field of interventional radiology. With an increasing breadth and complexity of procedures, IR physicians are frequently asked to intervene in situations where fluoroscopic guidance does not provide sufficient visualization, such as intracardiac targets or radiolucent materials such as thrombi. ICE can play a critical role in cases involving retrieval of radiolucent foreign bodies or intracardiac thrombus that cannot be visualized on traditional fluoroscopy.

Clinical Findings/Procedure Details:

A pictorial review of three cases where ICE or IVUS were successfully used are presented. The first case was a 66-year-old female with a retained radiolucent foreign body where ICE visualization allowed the precise localization of the foreign body and successful retrieval with lower radiation dose. The second case was a 30-year-old male with a catheter-related septic right atrial thrombus resistant to systemic antibiotics and catheter removal. ICE was used to direct suction thrombectomy which successfully removed infected chronic thrombus with minimal blood loss. The patient successfully cleared the bacterium after the removal of the thrombus. The third case was a 50-year-old female with a mobile right atrial thrombus and PFO with a right-to-left shunt, thus highly concerning for p<span style="color: #202124; background: white;">aradoxical systemic embolism. ICE was used to precisely localize the clot and to guide suction thrombectomy with minimal interatrial manipulation. The patient recovered well without any complications.

Conclusion and/or Teaching Points: IVUS and ICE are powerful tools that are infrequently used by interventional radiologists, though they can provide vital real-time image guidance and significantly lower the procedure time and patient dose. Interventional radiologists should become more familiar with applications IVUS and ICE as great additional tools, particularly when working close or inside the heart.