Intravascular ultrasound (IVUS) enables healthcare providers to assess blood vessels from the inside. It uses sound waves to check for narrowing and blockages that can compromise blood flow. IVUS is a minimally invasive procedure involving tiny FFR (Fractional Flow Reserve) is a guide wire-based procedure that can accurately measure blood pressure and blood flow through a part of the coronary artery. FFR is done through a standard diagnostic catheter at the time of coronary angiography. The measurement of Fractional Flow Reserve is useful in assessing whether or not to perform angioplasty on certain blockages.

Optical coherence tomography (OCT) is a novel invasive imaging technique done along with coronary angiography that produces high resolution intracoronary images. Using infrared light, OCT allows detailed evaluation of coronary atherosclerotic plaques and fills up the gaps in conventional invasive coronary angiography.

Sometimes, when the plaque (buildup of fat, cholesterol in artery’s inner lining) is particularly hard, or so narrow that the balloon can’t pass through it during angioplasty, rotablation may be used. A special catheter (a thin tube) is inserted along the wire with a tiny drill at its tip. This drill is used to grind away the plaque to gradually widen the narrowing in the artery. Once this is done, a balloon can be inserted and the angioplasty proceeds as usual.