Introduction/Purpose Intravascular ultrasonography (IVUS) is an innovative diagnostic tool with the potential to improve diagnostic and therapeutic accuracy, guiding the overall success of several intracranial, carotid, and jugular pathologies including but not limited to carotid artery stenosis, chronic cerebrospinal venous insufficiency, and cerebral venous disease including obstruction of venous outflow. Additionally, it can even pioneer and be incorporated into other unforeseen therapies, as is the case with ultrasound hyperthermia technology. Another incentive and unique aspect of IVUS as an imaging modality is that it does not require and limits administered contrast, thus beneficial in patients with worsening renal function and in scenarios where logistical constraints are placed on the acquisition of contrast.

Materials and Methods This project involves a comprehensive literature review to summarize the different utilities and advancements of IVUS to educate neuroendovascular proceduralists and garner awareness on its full spectrum of capabilities. Some of the more publicized researched areas that have incorporated IVUS include carotid artery interventions, chronic cerebrospinal venous insufficiency, evaluation for cerebral venous flow obstruction, carotid angioplasty, stenting, and the everyday evaluation of cerebrovascular disorders where the fraction flow and luminal characteristics are critical. Summarization of these different utilizations of IVUS in clinical practice, in addition to presenting supporting evidence, will be included in an ePoster for attendees to review.

Results After thorough literature review, it is apparent that IVUS is a unique and beneficial adjunct to the diagnosis and management of both intracranial and extracranial neurologic pathologies. For example, IVUS assessment of the jugular veins to evaluate cerebrospinal venous insufficiency against venogram has shown increased sensitivity and superiority for the detection of venous abnormalities and further identification and evaluation of the intrinsic and extrinsic causes of insufficiency. Not only does IVUS allow for real-time procedural evaluation with increased sensitivity, but it pushes past limitations found in diagnostic imaging. When compared to magnetic resonance venography, flow gaps that are common in areas of slow or turbulent flow patterns are alleviated. IVUS can also be used during intraprocedural planning and in the immediate and follow-up postprocedural setting, to assist in the overall prognostic evaluation and efficacy, critical in the management following angioplasty and stenting. The high-resolution images provided by IVUS add value in determining plaque and thrombus morphology and chronicity, helping in the identification of optimized treatment areas. These real-time images during treatments provide a recorded baseline for further association with later treatments.

Conclusion This literature review and summarization of the clinical utility of IVUS aims to educate providers on the variety of applications of IVUS as a valuable adjunct in patient care in addition to the supporting evidence behind each application, including comparison to other imaging modalities. In conclusion, IVUS remains a powerful tool in endovascular interventions for both cerebral venous disease and carotid artery interventions. The hope is to one day develop a formal future consensus for the standardized practice parameters for all of the previously listed utilizations, especially due to the low-risk profile and minimal complication rate of IVUS as a diagnostic imaging modality.

Disclosures A. Richardson: None. O. Richardson: None.