Dr. Gary Milechman is about to take a life saving journey into the damaged arteries of a 76-year-old heart patient. A woman so short of breath, she can't climb a flight of stairs.
First, the traditional angiogram, after winding a long catheter toward her heart and injecting dye, there's evidence of severe blockage.
A stent is the thin tube-shaped mesh placed on the end of a catheter. Once it's inserted, a removable balloon will expand it against the artery walls to provide support.
But choosing the correct stent size is critical, and can depend on guessing the true diameter of the artery, now obscured by the blockage.
"In an angiogram, there's no way to tell where the vessel used to be," said Dr. Milechman.
So we joined Dr. Milechman in the operating room at California Pacific Medical Center, for an amazingly detailed look inside the arteries.
"So that is the IVUS catheter that has a little rotating head in it that gives us those ultrasound images. So one of our guesses here is to see how big that vessel really is, how big a stem do we need," said Dr. Milechman.
Within minutes, the tiny intravascular ultrasound is producing a two-dimensional view.
"That the radial image. The black line is the true vessel size and the rest is plaque filling the vessel," said Dr. Milechman.
The image tells him exactly what size stents he should use to re-open two major arteries, and exactly where he needs to place them.
"One side at a time?" asked ABC7's Carolyn Johnson.
"Right If everything goes right, we'll fix everything," said Dr. Milechman.
And within 90 minutes, two stents are inserted through the catheter, and into the damaged arteries.
The screen shows blood flow that's now almost back to normal, and it gives Dr. Milcheman the news he's happy to pass on.
"You're not going to need that pacemaker right now, no because there is a good chance your heart is going to get stronger and you are going to feel better," said Dr. Milcheman
THE IVUS technology can also be used after other coronary procedures, allowing surgeons to check whether the surgeries were successful.