Brown Emile N, Burris Nicholas S, Gu Junyan, Kon Zachary N, Laird Patrick, Kallam Seeta, Tang Cha-Min, Schmitt Joseph M, Poston Robert S
University of Maryland, School of Medicine, Department of Cardiac Surgery, 22 South Greene Street N4W94, Baltimore, Maryland 21201, USA.
J Biomed Opt. 2007 Sep-Oct;12(5):051704. doi: 10.1117/1.2799521.
Recent advances in catheter-based optical coherence tomography (OCT) have provided the necessary resolution and acquisition speed for high-quality intravascular imaging. Complications associated with clearing blood from the vessel of a living patient have prevented its wider acceptance. We identify a surgical application that takes advantage of the vascular imaging powers of OCT but that circumvents the difficulties. Coronary artery bypass grafting (CABG) is the most commonly performed major surgery in America. A critical determinant of its outcome has been postulated to be injury to the conduit vessel incurred during the harvesting procedure or pathology preexistent in the harvested vessel. As a test of feasibility, intravascular OCT imaging is obtained from the radial arteries (RAs) and/or saphenous veins (SVs) of 35 patients scheduled for CABG. Pathologies detected by OCT are compared to registered histological sections obtained from discarded segments of each graft. OCT reliably detects atherosclerotic lesions in the RAs and discerns plaque morphology as fibrous, fibrocalcific, or fibroatheromatous. OCT is also used to assess intimal trauma and residual thrombi related to endoscopic harvest and the quality of the distal anastomosis. We demonstrate the feasibility of OCT imaging as an intraoperative tool to select conduit vessels for CABG.
基于导管的光学相干断层扫描（OCT）技术的最新进展为高质量血管内成像提供了必要的分辨率和采集速度。与清除活体患者血管内血液相关的并发症阻碍了其更广泛的应用。我们确定了一种手术应用，该应用利用了OCT的血管成像能力，但规避了相关困难。冠状动脉旁路移植术（CABG）是美国最常进行的大型手术。据推测，其结果的一个关键决定因素是在获取过程中对移植血管造成的损伤或移植血管中预先存在的病变。作为可行性测试，对35例计划进行CABG的患者的桡动脉（RA）和/或大隐静脉（SV）进行血管内OCT成像。将OCT检测到的病变与从每个移植血管废弃段获取的已登记组织学切片进行比较。OCT能够可靠地检测RA中的动脉粥样硬化病变，并识别斑块形态为纤维性、纤维钙化性或纤维粥样性。OCT还用于评估与内镜获取相关的内膜损伤和残留血栓以及远端吻合口的质量。我们证明了OCT成像作为一种术中工具为CABG选择移植血管的可行性。
