Intravascular ultrasound: questions and answers

SİPAHİ, İlke; GÜLEL, Okan; TUZCU, E. Murat

Intravascular ultrasound: questions and answers

Okan GÜLEL, (Ondokuz Mayıs Üniversitesi, Tıp Fakültesi, Kardiyoloji Anabilim Dalı, Samsun, Türkiye)

İlke SİPAHİ, (Department, of Cardiovascular Medicine. The Cleveland Clinic Foundation, Cleveland, Ohio, USA)

E. Murat TUZCU (Department, of Cardiovascular Medicine. The Cleveland Clinic Foundation, Cleveland, Ohio, USA)

Anadolu Kardiyoloji Dergisi

5 0

Yıl: 2007 Cilt: 7 Sayı: 2 Sayfa Aralığı: 169 - 178 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

Intravascular ultrasound: questions and answers

Öz:

Koroner arter hastalığının saptanmasında koroner anjiyografi altın standarttır. Fakat koroner anjiyografi sadece koroner arterlerin lümeni hakkında bilgi vermektedir. İntravasküler ultrason (İVUS) koroner arterlerin görüntülenmesinde yeni bir bakış açısı sağlamıştır. İntravasküler ultrason sadece lümenin değil damar duvarı ve aterosklerotik plağın da değerlendirilmesine olanak sağlamaktadır. Bu makalede, koroner arterlerin İVUS ile görüntülenme tekniği, kullanılan ölçümler ve güncel İVUS uygulamaları soru-cevap şeklinde gözden geçirilmiştir.

Anahtar Kelime: Koroner arter hastalığı Ultrasonografi, girişimsel Hastalık ciddiyet indeksi Tanısal görüntüleme Tanı teknikleri, kalp damar

Konular: Kalp ve Kalp Damar Sistemi

İntravasküler ultrason: Sorular ve cevaplar

Öz:

Coronary angiography is the gold standard for the detection of coronary artery disease, but it only gives information about the lumen of the coronary arteries. Intravascular ultrasound (IVUS) has provided a new perspective for imaging the coronary arteries. It allows assessment of not only the lumen but also the vessel wall and atherosclerotic plaque. In this article, we review the technique, measurements and current applications of IVUS imaging of the coronaries in a question-answer format.

Anahtar Kelime: Diagnostic Techniques, Cardiovascular Coronary Artery Disease Ultrasonography, Interventional Severity of Illness Index Diagnostic Imaging

Konular: Kalp ve Kalp Damar Sistemi

Belge Türü: Makale Makale Türü: Derleme Erişim Türü: Erişime Açık

1. Nissen SE, Yock P. Intravascular ultrasound: novel pathophysiological insights and current clinical applications. Circulation 2001; 103: 604-16.
2. Mintz GS, Nissen SE, Anderson WD, Bailey SR, Erbel R, Fitzgerald PJ, et al. American College of Cardiology Clinical Expert Consensus Document on Standards for Acquisition, Measurement and Reporting of Intravascular Ultrasound Studies (IVUS). A report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol 2001; 37: 1478-92.
3. Di Mario C, Gorge G, Peters R, Kearney P, Pinto F, Hausmann D, et al. Clinical application and image interpretation in intracoronary ultrasound. Study Group on Intracoronary Imaging of the Working Group of Coronary Circulation and of the Subgroup on Intravascular Ultrasound of the Working Group of Echocardiography of the European Society of Cardiology. Eur Heart J 1998; 19: 207-29.
4. Schoenhagen P, Nissen SE. An atlas and manual of coronary intravascular ultrasound imaging. 1st ed. New York: Parthenon Publishing Group; 2004. p. 6.
5. Gil R, Von Birgelen C, Prati F, Di Mario C, Ligthart J, Serruys PW. Usefulness of three-dimensional reconstruction for interpretation and quantitative analysis of intracoronary ultrasound during stent deployment. Am J Cardiol 1996; 77: 761-4.
6. Evans JL, Ng KH, Wiet SG, Vonesh MJ, Burns WB, Radvany MG, et al. Accurate three-dimensional reconstruction of intravascular ultrasound data. Spatially correct three-dimensional reconstructions. Circulation 1996; 93: 567-76.
7. Klingensmith JD, Schoenhagen P, Tajaddini A, Halliburton SS, Tuzcu EM, Nissen SE, et al. Automated three-dimensional assessment of coronary artery anatomy with intravascular ultrasound scanning. Am Heart J 2003; 145: 795-805.
8. Nair A, Kuban BD, Tuzcu EM, Schoenhagen P, Nissen SE, Vince DG. Coronary plaque classification with intravascular ultrasound radiofrequency data analysis. Circulation 2002; 106: 2200-6.
9. Kawasaki M, Takatsu H, Noda T, Ito Y, Kunishima A, Arai M, et al. Noninvasive quantitative tissue characterization and two-dimensional color-coded map of human atherosclerotic lesions using ultrasound integrated backscatter: comparison between histology and integrated backscatter images. J Am Coll Cardiol 2001; 38: 486-92.
10. de Korte CL, Pasterkamp G, van der Steen AF, Woutman HA, Bom N. Characterization of plaque components with intravascular ultrasound elastography in human femoral and coronary arteries in vitro. Circulation 2000; 102: 617-23.
11. Nishimura RA, Edwards WD, Warnes CA, Reeder GS, Holmes DR Jr, Tajik AJ, et al. Intravascular ultrasound imaging: in vitro validation and pathologic correlation. J Am Coll Cardiol 1990; 16: 145-54.
12. Fitzgerald PJ, St. Goar FG, Connolly AJ, Pinto FJ, Billingham ME, Popp RL, et al. Intravascular ultrasound imaging of coronary arteries. Is three layers the norm? Circulation 1992; 86: 154-8.
13. Schoenhagen P, Nissen SE. An atlas and manual of coronary intravascular ultrasound imaging. 1st ed. New York: Parthenon Publishing Group; 2004. p.10-11.
14. Wong M, Edelstein J, Wollman J, Bond MG. Ultrasonic-pathological comparison of the human arterial wall. Verification of intima-media thickness. Arterioscler Thromb 1993; 13: 482-6.
15. Ge J, Erbel R, Gerber T, Gorge G, Koch L, Haude M, et al. Intravascular ultrasound imaging of angiographically normal coronary arteries: a prospective study in vivo. Br Heart J 1994; 71: 572-8.
16. Nakamura S, Colombo A, Gaglione A, Almagor Y, Goldberg SL, Maiello L, et al. Intracoronary ultrasound observations during stent implantation. Circulation 1994; 89: 2026-34.
17. Costa MA, Sabate M, Angiolillo DJ, Jimenez-Quevedo P, Teirstein P, Carter A, et al. Intravascular ultrasound characterization of the "black hole" phenomenon after drug-eluting stent implantation. Am J Cardiol 2006; 97: 203-6.
18. Glagov S, Weisenberg E, Zarins CK, Stankunavicius R, Kolettis GJ. Compensatory enlargement of human atherosclerotic coronary arteries. N Engl J Med 1987; 316: 1371-5.
19. Schoenhagen P, Ziada K, Kapadia SR, Crowe TD, Nissen SE, Tuzcu EM. Extent and direction of arterial remodeling in stable versus unstable coronary syndromes: an intravascular ultrasound study. Circulation 2000; 101: 598-603.
20. Sipahi I, Tuzcu EM, Schoenhagen P, et al. Discordance between static and serial assessments of arterial remodeling: an intravascular ultrasound analysis from the Reversal of Atherosclerosis with Aggressive Lipid Lowering (REVERSAL) Trial. Am Heart J 2006 (in press).
21. Mintz GS, Kent KM, Pichard AD, Satler LF, Popma JJ, Leon MB. Contribution of inadequate arterial remodeling to the development of focal coronary artery stenoses: An intravascular ultrasound study. Circulation 1997; 95: 1791-8.
22. Nishioka T, Luo H, Eigler NL, Berglund H, Kim CJ, Siegel RJ. Contribution of inadequate compensatory enlargement to development of human coronary artery stenosis: an in vivo intravascular ultrasound study. J Am Coll Cardiol 1996; 27: 1571–6.
23. Tuzcu EM, Berkalp B, De Franco AC, Ellis SG, Goormastic M, Whitlow PL, et al. The dilemma of diagnosing coronary calcification: angiography versus intravascular ultrasound. J Am Coll Cardiol 1996; 27: 832-8.
24. Nissen SE. Application of intravascular ultrasound to characterize coronary artery disease and assess the progression or regression of atherosclerosis. Am J Cardiol 2002; 89(Suppl 4A): 24B-31B.
25. Metz JA, Yock PG, Fitzgerald PJ. Intravascular ultrasound: basic interpretation. Cardiol Clin 1997; 15: 1-15.
26. Fayad ZA, Fuster V. Clinical imaging of the high-risk or vulnerable atherosclerotic plaque. Circ Res 2001; 89: 305-16.
27. Burke AP, Farb A, Malcom GT, Liang YH, Smialek J, Virmani R. Coronary risk factors and plaque morphology in men with coronary disease who died suddenly. N Engl J Med 1997; 336: 1276-82.
28. Kearney P, Erbel R, Rupprecht HJ, Ge J, Koch L, Voigtlander T, et al. Differences in the morphology of unstable and stable coronary lesions and their impact on the mechanisms of angioplasty. An invivo study with intravascular ultrasound. Eur Heart J 1996; 17: 721-30.
29. Bocksch W, Schartl M, Beckmann S, Dreysse S, Fleck E. Intravascular ultrasound imaging in patients with acute myocardial infarction. Eur Heart J 1995; 16 Suppl J: 46-52.
30. Schoenhagen P, Vince DG, Ziada KM, Tsutsui H, Jeremias A, Crowe TD, et al. Association of arterial expansion (expansive remodeling) of bifurcation lesions determined by intravascular ultrasonography with unstable clinical presentation. Am J Cardiol 2001; 88: 785-7.
31. Small DM, Bond MG, Waugh D, Prack M, Sawyer JK. Physicochemical and histological changes in the arterial wall of nonhuman primates during progression and regression of atherosclerosis. J Clin Invest 1984; 73: 1590-605.
32. Siegel RJ, Ariani M, Fishbein MC, Chae JS, Park JC, Maurer G, et al. Histopathologic validation of angioscopy and intravascular ultrasound. Circulation 1991; 84: 109-17.
33. Chung IM, Gold HK, Schwartz SM, Ikari Y, Reidy MA, Wight TN. Enhanced extracellular matrix accumulation in restenosis of coronary arteries after stent deployment. J Am Coll Cardiol 2002; 40: 2072-81.
34. Smith SC Jr, Dove JT, Jacobs AK, Kennedy JW, Kereiakes D, Kern MJ, et al. ACC/AHA guidelines for percutaneous coronary intervention (revision of the 1993 PTCA guidelines)-executive summary: a report of the American College of Cardiology/American Heart Association task force on practice guidelines (Committee to revise the 1993 guidelines for percutaneous transluminal coronary angioplasty) endorsed by the Society for Cardiac Angiography and Interventions. Circulation 2001; 103: 3019-3041.
35. Ziada KM, Tuzcu EM, De Franco AC, Kim MH, Raymond RE, Franco I, et al. Intravascular ultrasound assessment of the prevalence and causes of angiographic ‘haziness’ following high-pressure coronary stenting. Am J Cardiol 1997; 80: 116-21.
36. Lee DY, Eigler N, Luo H, Nishioka T, Tabak SW, Forrester JS, et al. Effect of intracoronary ultrasound imaging on clinical decision making. Am Heart J 1995; 129: 1084-93.
37. Iyisoy A, Ziada K, Schoenhagen P, Tsutsui H, Kapadia S, Popovich J, et al. Intravascular ultrasound evidence of ostial narrowing in nonatherosclerotic left main coronary arteries. Am J Cardiol 2002; 90: 773-5.
38. Briguori C, Anzuini A, Airoldi F, Gimelli G, Nishida T, Adamian M, et al. Intravascular ultrasound criteria for the assessment of the functional significance of intermediate coronary artery stenoses and comparison with fractional flow reserve. Am J Cardiol 2001; 87: 136-41.
39. Abizaid AS, Mintz GS, Mehran R, Abizaid A, Lansky AJ, Pichard AD, et al. Long-term follow-up after percutaneous transluminal coronary angioplasty was not performed based on intravascular ultrasound findings: importance of lumen dimensions. Circulation 1999; 100: 256-61.
40. Jasti V, Ivan E, Yalamanchili V, Wongpraparut N, Leesar MA. Correlations between fractional flow reserve and intravascular ultrasound in patients with an ambiguous left main coronary artery stenosis. Circulation 2004; 110: 2831-36.
41. Abizaid AS, Mintz GS, Abizaid A, Mehran R, Lansky AJ, Pichard AD, et al. One-year follow-up after intravascular ultrasound assessment of moderate left main coronary artery disease in patients with ambiguous angiograms. J Am Coll Cardiol 1999; 34: 707-15.
42. Dressler FA, Miller LW. Necropsy versus angiography: how accurate is angiography? J Heart Lung Transplant 1992; 11 (Suppl): S56–9.
43. Ramasubbu K, Schoenhagen P, Balghith MA, Brechtken J, Ziada KM, Kapadia SR, et al. Repeated intravascular ultrasound imaging in cardiac transplant recipients does not accelerate transplant coronary artery disease. J Am Coll Cardiol 2003; 41: 1739-43.
44. Tuzcu EM, Kapadia SR, Sachar R, Ziada KM, Crowe TD, Feng J, et al. Intravascular ultrasound evidence of angiographically silent progression in coronary atherosclerosis predicts long-term morbidity and mortality after cardiac transplantation. J Am Coll Cardiol 2005; 45: 1538-42.
45. Kobashigawa JA, Tobis JM, Starling RC, Tuzcu EM, Smith AL, Valantine HA, et al. Multicenter intravascular ultrasound validation study among heart transplant recipients: outcomes after five years. J Am Coll Cardiol 2005; 45: 1532-7.
46. Kapadia SR, Nissen SE, Ziada KM, Guetta V, Crowe TD, Hobbs RE, et al. Development of transplantation vasculopathy and progression of donor-transmitted atherosclerosis: comparison by serial intravascular ultrasound imaging. Circulation 1998; 98: 2672-8.
47. Gao HZ, Hunt SA, Alderman EL, Liang D, Yeung AC, Schroeder JS. Relation of donor age and preexisting coronary artery disease on angiography and intracoronary ultrasound to later development of accelerated allograft coronary artery disease. J Am Coll Cardiol 1997; 29: 623-9.
48. Kobashigawa JA, Katznelson S, Laks H, Johnson JA, Yeatman L, Wang XM, et al. Effect of pravastatin on outcomes after cardiac transplantation. N Engl J Med 1995; 333: 621-7.
49. Mehra MR, Ventura HO, Smart FW, Collins TJ, Ramee SR, Stapleton DD. An intravascular ultrasound study of the influence of angiotensin-converting enzyme inhibitors and calcium entry blockers on the development of cardiac allograft vasculopathy. Am J Cardiol 1995; 75: 853-4.
50. Fang JC, Kinlay S, Beltrame J, Hikiti H, Wainstein M, Behrendt D, et al. Effect of vitamins C and E on progression of transplant-associated arteriosclerosis: a randomised trial. Lancet 2002; 359: 1108-13.
51. Eisen HJ, Tuzcu EM, Dorent R, Kobashigawa J, Mancini D, Valantine-von Kaeppler HA, et al. Everolimus for the prevention of allograft rejection and vasculopathy in cardiac-transplant recipients. N Engl J Med 2003; 349: 847-58.
52. Mintz GS, Pichard AD, Kovach JA, Kent KM, Satler LF, Javier SP, et al. Impact of preintervention intravascular ultrasound imaging on transcatheter treatment strategies in coronary artery disease. Am J Cardiol 1994; 73: 423-30.
53. Kornowski R, Mintz GS, Kent KM, Pichard AD, Satler LF, Bucher TA, et al. Increased restenosis in diabetes mellitus after coronary interventions is due to exaggerated intimal hyperplasia: A serial intravascular ultrasound study. Circulation 1997; 95: 1366-9.
54. Stone GW, Hodgson JM, St Goar FG, Frey A, Mudra H, Sheehan H, et al. Improved procedural results of coronary angioplasty with intravascular ultrasound-guided balloon sizing: the CLOUT Pilot Trial: Clinical Outcomes With Ultrasound Trial (CLOUT) Investigators. Circulation 1997; 95: 2044-52.
55. Abizaid A, Pichard AD, Mintz GS, Abizaid AS, Klutstein MW, Satler LF, et al. Acute and long-term results of an intravascular ultrasound-guided percutaneous transluminal coronary angioplasty/provisional stent implantation strategy. Am J Cardiol 1999; 84: 1298-303.
56. Matar FA, Mintz GS, Pinnow E, Javier SP, Popma JJ, Kent KM, et al. Multivariate predictors of intravascular ultrasound end points after directional coronary atherectomy. J Am Coll Cardiol 1995; 25: 318-24.
57. Tsuchikane E, Sumitsuji S, Awata N, Nakamura T, Kobayashi T, Izumi M, et al. Final results of the STent versus directional coronary Atherectomy Randomized Trial (START). J Am Coll Cardiol 1999; 34: 1050-7.
58. Casserly IP, Aronow HD, Schoenhagen P, Tsutsui H, Popovich J, Goormastic M, et al. Relationship between residual atheroma burden and neointimal growth in patients undergoing stenting: analysis of the atherectomy before MULTI-LINK improves lumen gain and clinical outcomes trial intravascular ultrasound substudy. J Am Coll Cardiol 2002; 40: 1573-8.
59. De Franco AC, Nissen SE, Tuzcu EM, Whitlow PL. Incremental value of intravascular ultrasound during rotational coronary atherectomy. Cathet Cardiovasc Diagn 1996; Suppl 3 :23-33.
60. Colombo A, Hall P, Nakamura S, Almagor Y, Maiello L, Martini G, et al. Intracoronary stenting without anticoagulation accomplished with intravascular ultrasound guidance. Circulation 1995; 91: 1676-88.
61. Moussa I, Moses J, Di Mario C, Albiero R, De Gregorio J, Adamian M, et al. Does the specific intravascular ultrasound criterion used to optimize stent expansion have an impact on the probability of stent restenosis? Am J Cardiol 1999; 83: 1012-7.
62. Albiero R, Rau T, Schluter M, Di Mario C, Reimers B, Mathey DG, et al. Comparison of immediate and intermediate-term results of intravascular ultrasound versus angiography-guided Palmaz-Schatz stent implantation in matched lesions. Circulation 1997; 96: 2997–3005.
63. Blasini R, Neumann FJ, Schmitt C, Walter H, Schomig A. Restenosis rate after intravascular ultrasound-guided coronary stent implantation. Cathet Cardiovasc Diagn 1998; 44: 380–6.
64. Fitzgerald PJ, Oshima A, Hayase M, Metz JA, Bailey SR, Baim DS, et al. Final results of the Can Routine Ultrasound Influence Stent Expansion (CRUISE) study. Circulation 2000; 102: 523–30.
65. Choi JW, Goodreau LM, Davidson CJ. Resource utilization and clinical outcomes of coronary stenting: a comparison of intravascular ultrasound and angiographical guided stent implantation. Am Heart J 2001; 142: 112–8.
66. Orford JL, Denktas AE, Williams BA, Fasseas P, Willerson JT, Berger PB, et al. Routine intravascular ultrasound scanning guidance of coronary stenting is not associated with improved clinical outcomes. Am Heart J 2004; 148: 501–6.
67. Schiele F, Meneveau N, Vuillemenot A, Zhang DD, Gupta S, Mercier M, et al. Impact of intravascular ultrasound guidance in stent deployment on 6-month restenosis rate: a multicenter, randomized study comparing two strategies–with and without intravascular ultrasound guidance. RESIST Study Group. REStenosis after Ivus guided STenting. J Am Coll Cardiol 1998; 32: 320–8.
68. Mudra H, di Mario C, de Jaegere P, Figulla HR, Macaya C, Zahn R, et al. Randomized comparison of coronary stent implantation under ultrasound or angiographic guidance to reduce stent restenosis (OPTICUS Study). Circulation 2001; 104: 1343–9.
69. Oemrawsingh PV, Mintz GS, Schalij MJ, Zwinderman AH, Jukema JW, van der Wall EE.Intravascular ultrasound guidance improves angiographic and clinical outcome of stent implantation for long coronary artery stenoses: final results of a randomized comparison with angiographic guidance (TULIP Study). Circulation 2003; 107: 62-7.
70. Hoffmann R, Mintz GS, Dussaillant GR, Popma JJ, Pichard AD, Satler LF, et al. Patterns and mechanisms of in-stent restenosis: A serial intravascular ultrasound study. Circulation 1996; 94: 1247-54.
71. Fujii K, Mintz GS, Kobayashi Y, Carlier SG, Takebayashi H, Yasuda T, et al. Contribution of stent underexpansion to recurrence after sirolimus-eluting stent implantation for in-stent restenosis. Circulation 2004; 109: 1085-8.
72. Uren NG, Schwarzacher SP, Metz JA, Lee DP, Honda Y, Yeung AC, et al; POST Registry Investigators. Predictors and outcomes of stent thrombosis: an intravascular ultrasound registry. Eur Heart J 2002; 23: 124-32.
73. Hansen A, Hehrlein C, Hardt S, Bekeredjian R, Brachmann J, Kubler W, et al. Is the ‘candy wrapper’ effect of (32)P radioactive beta-emitting stents due to remodeling or neointimal hyperplasia? Insights from intravascular ultrasound. Catheter Cardiovasc Interv 2001; 54: 41–8.
74. Serruys PW, Degertekin M, Tanabe K, Abizaid A, Sousa JE, Colombo A, et al. Intravascular ultrasound findings in the multicenter, randomized, double-blind RAVEL (RAndomized study with the sirolimus-eluting VElocity balloon-expandable stent in the treatment of patients with de novo native coronary artery Lesions) trial. Circulation 2002; 106: 798-803.
75. Colombo A, Drzewiecki J, Banning A, Grube E, Hauptmann K, Silber S, et al. Randomized study to assess the effectiveness of slow-and moderate-release polymer-based paclitaxel-eluting stents for coronary artery lesions. Circulation 2003; 108: 788-94.
76 Oesterle SN, Limpijankit T, Yeung AC, Stertzer S, Pomerantsev E, Yock PG, et al. Ultrasound logic: the value of intracoronary imaging for the interventionalist. Cathet Cardiovasc Intervent 1999; 47: 475-90.
77. Maehara A, Takagi A, Okura H, Hassan AH, Bonneau HN, Honda Y, et al. Longitudinal plaque redistribution during stent expansion. Am J Cardiol 2000; 86: 1069– 72.
78. Sipahi I, Tuzcu EM, Schoenhagen P, Nicholls SJ, Kapadia S, Nissen SE. Paradoxical increase in lumen size during progression of coronary atherosclerosis: observations from the REVERSAL trial. Atherosclerosis 2006 Jan 19 (epub ahead of print).
79. Nicholls SJ, Tuzcu EM, Sipahi I, Schoenhagen P, Crowe T, Kapadia S, et al. Relationship between atheroma regression and change in lumen size after infusion of apolipoprotein A-I Milano. J Am Coll Cardiol 2006; 47: 992-7.
80. Nissen SE, Tuzcu EM, Schoenhagen P, Brown BG, Ganz P, Vogel RA, et al. REVERSAL Investigators. Effect of intensive compared with moderate lipid-lowering therapy on progression of coronary atherosclerosis: a randomized controlled trial. JAMA 2004; 291: 1071–80.
81. Nissen SE, Tsunoda T, Tuzcu EM, Schoenhagen P, Cooper CJ, Yasin M, et al. Effect of recombinant ApoA-I Milano on coronary atherosclerosis in patients with acute coronary syndromes: a randomized controlled trial. JAMA 2003; 290: 2292-300.
82. Nissen SE, Tuzcu EM, Libby P, Thompson PD, Ghali M, Garza D, et al. CAMELOT Investigators. Effect of antihypertensive agents on cardiovascular events in patients with coronary disease and normal blood pressure: the CAMELOT study: a randomized controlled trial. JAMA 2004; 292: 2217-25.
83. Nissen SE, Nicholls SJ, Sipahi I, Libby P, Raichlen JS, Ballantyne CM, et al. Effect of very high-intensity statin therapy on regression of coronary atherosclerosis: The ASTEROID Trial. JAMA 2006; 295: 1556-65.
84. Nissen SE, Tuzcu EM, Brewer HB, Sipahi I, Nicholls SJ, Ganz P, et al; ACAT Intravascular Atherosclerosis Treatment Evaluation (ACTIVATE) Investigators. Effect of ACAT inhibition on the progression of coronary atherosclerosis. N Engl J Med 2006; 354: 1253-63.
85. Hausmann D, Erbel R, Alibelli-Chemarin MJ, Boksch W, Caracciolo E, Cohn JM, et al. The safety of intracoronary ultrasound: A multicenter survey of 2207 examinations. Circulation 1995; 91: 623–30.
86. Yock PG, Fitzgerald PJ. Intravascular ultrasound: state of the art and future directions. Am J Cardiol 1998; 81(Suppl 7A): 27E-32E.

APA	GÜLEL O, SİPAHİ İ, TUZCU E (2007). Intravascular ultrasound: questions and answers. , 169 - 178.
Chicago	GÜLEL Okan,SİPAHİ İlke,TUZCU E. Murat Intravascular ultrasound: questions and answers. (2007): 169 - 178.
MLA	GÜLEL Okan,SİPAHİ İlke,TUZCU E. Murat Intravascular ultrasound: questions and answers. , 2007, ss.169 - 178.
AMA	GÜLEL O,SİPAHİ İ,TUZCU E Intravascular ultrasound: questions and answers. . 2007; 169 - 178.
Vancouver	GÜLEL O,SİPAHİ İ,TUZCU E Intravascular ultrasound: questions and answers. . 2007; 169 - 178.
IEEE	GÜLEL O,SİPAHİ İ,TUZCU E "Intravascular ultrasound: questions and answers." , ss.169 - 178, 2007.
ISNAD	GÜLEL, Okan vd. "Intravascular ultrasound: questions and answers". (2007), 169-178.

APA	GÜLEL O, SİPAHİ İ, TUZCU E (2007). Intravascular ultrasound: questions and answers. Anadolu Kardiyoloji Dergisi, 7(2), 169 - 178.
Chicago	GÜLEL Okan,SİPAHİ İlke,TUZCU E. Murat Intravascular ultrasound: questions and answers. Anadolu Kardiyoloji Dergisi 7, no.2 (2007): 169 - 178.
MLA	GÜLEL Okan,SİPAHİ İlke,TUZCU E. Murat Intravascular ultrasound: questions and answers. Anadolu Kardiyoloji Dergisi, vol.7, no.2, 2007, ss.169 - 178.
AMA	GÜLEL O,SİPAHİ İ,TUZCU E Intravascular ultrasound: questions and answers. Anadolu Kardiyoloji Dergisi. 2007; 7(2): 169 - 178.
Vancouver	GÜLEL O,SİPAHİ İ,TUZCU E Intravascular ultrasound: questions and answers. Anadolu Kardiyoloji Dergisi. 2007; 7(2): 169 - 178.
IEEE	GÜLEL O,SİPAHİ İ,TUZCU E "Intravascular ultrasound: questions and answers." Anadolu Kardiyoloji Dergisi, 7, ss.169 - 178, 2007.
ISNAD	GÜLEL, Okan vd. "Intravascular ultrasound: questions and answers". Anadolu Kardiyoloji Dergisi 7/2 (2007), 169-178.