IVUS-Guided Stent Sizing in May-Thurner Syndrome: Practical Tips for Optimal Vessel Wall Apposition

Monday, April 13, 2026

5:33 PM - 5:39 PM ET

Location: 717

Abstract Presenter(s)

Satya K. Morar, MS (he/him/his)

Medical Student
Case Western Reserve University School of Medicine, Ohio, United States

Author/Co-author(s)

MA

Mark Abboud, BA

Medical Student
Case Western Reserve University, Ohio, United States
CM

Charles Martin, III, MD, FSIR, MBA (he/him/his)

Staff Physician
Cleveland Clinic Foundation, Ohio, United States

Learning Objectives: After reviewing this exhibit, participants will be able to: (1) perform systematic IVUS measurements for accurate stent sizing, (2) recognize anatomical landmarks for optimal stent positioning, (3) implement post-deployment optimization techniques, and (4) identify and correct common deployment errors affecting long-term patency.

Background: Improper stent sizing in May-Thurner syndrome contributes to restenosis rates of 10-15% within two years. IVUS guidance has been shown to improve outcomes by enabling accurate vessel measurement and optimal stent deployment. This exhibit outlines practical approaches for IVUS-guided stent placement, with an emphasis on sizing accuracy and wall apposition optimization through real-world case examples.

Clinical Findings/Procedure Details: The exhibit demonstrates a systematic IVUS measurement technique that involves measuring vessel diameter at multiple points along the compression zone, identifying the transition from compressed to normal caliber vessel, and accounting for vessel tapering. Stent sizing guidelines recommend oversizing by 10-15% relative to the normal vessel diameter, extending stents 1-2 cm beyond compression zones, and utilizing self-expanding nitinol stents for optimal radial force. Post-deployment optimization consists of high-pressure balloon dilatation (12-16 atm) for stent expansion, followed by repeat IVUS to confirm wall apposition and pressure measurements to document gradient relief. Common errors addressed include undersizing, which can lead to incomplete expansion; inadequate stent length, which may cause edge dissection; and failure to address residual stenosis at stent margins.

Conclusion and/or Teaching Points: IVUS guidance significantly improves stent sizing accuracy in May-Thurner syndrome. Systematic measurement protocols prevent common sizing errors, while post-deployment optimization ensures optimal wall apposition and long-term patency. Immediate implementation of these practical techniques can significantly improve procedural outcomes.