Tearney Guillermo J, Waxman Sergio, Shishkov Milen, Vakoc Benjamin J, Suter Melissa J, Freilich Mark I, Desjardins Adrien E, Oh Wang-Yul, Bartlett Lisa A, Rosenberg Mireille, Bouma Brett E
Wellman Center for Photomedicine, Massachusetts General Hospital, Department of Pathology, Harvard Medical School, Boston, Massachusetts 02114, USA.
JACC Cardiovasc Imaging. 2008 Nov;1(6):752-61. doi: 10.1016/j.jcmg.2008.06.007.
We present the first clinical experience with intracoronary optical frequency domain imaging (OFDI) in human patients.
Intracoronary optical coherence tomography (OCT) is a catheter-based optical imaging modality that is capable of providing microscopic (approximately 7-microm axial resolution, approximately 30-microm transverse resolution), cross-sectional images of the coronary wall. Although the use of OCT has shown substantial promise for imaging coronary microstructure, blood attenuates the OCT signal, necessitating prolonged, proximal occlusion to screen long arterial segments. OFDI is a second-generation form of OCT that is capable of acquiring images at much higher frame rates. The increased speed of OFDI enables rapid, 3-dimensional imaging of long coronary segments after a brief, nonocclusive saline purge.
Volumetric OFDI images were obtained in 3 patients after intracoronary stent deployment. Imaging was performed in the left anterior descending and right coronary arteries with the use of a nonocclusive saline purge rates ranging from 3 to 4 ml/s and for purge durations of 3 to 4 s. After imaging, the OFDI datasets were segmented using previously documented criteria and volume rendered.
Good visualization of the artery wall was obtained in all cases, with clear viewing lengths ranging from 3.0 to 7.0 cm at pullback rates ranging from 5 to 20 mm/s. A diverse range of microscopic features were identified in 2 and 3 dimensions, including thin-capped fibroatheromas, calcium, macrophages, cholesterol crystals, bare stent struts, and stents with neointimal hyperplasia. There were no complications of the OFDI procedure.
Our results demonstrate that OFDI is a viable method for imaging the microstructure of long coronary segments in patients. Given its ability to provide microscopic information in a practical manner, this technology may be useful for studying human coronary pathophysiology in vivo and as a clinical tool for guiding the management of coronary artery disease.
我们展示了冠状动脉内光学频域成像（OFDI）在人类患者中的首次临床经验。
冠状动脉内光学相干断层扫描（OCT）是一种基于导管的光学成像方式，能够提供冠状动脉壁的微观（轴向分辨率约7微米，横向分辨率约30微米）横断面图像。尽管OCT的应用已显示出在冠状动脉微观结构成像方面的巨大前景，但血液会衰减OCT信号，因此需要长时间的近端闭塞来筛查长动脉段。OFDI是OCT的第二代形式，能够以更高的帧率获取图像。OFDI速度的提高使得在短暂的非闭塞性盐水冲洗后能够对长冠状动脉段进行快速三维成像。
在3例患者冠状动脉内支架置入后获取容积性OFDI图像。使用非闭塞性盐水冲洗，冲洗速度为3至4 ml/s，冲洗持续时间为3至4 s，在左前降支和右冠状动脉进行成像。成像后，根据先前记录的标准对OFDI数据集进行分割并进行容积渲染。
所有病例均获得了动脉壁的良好可视化效果，在5至20 mm/s的回撤速度下，清晰的观察长度为3.0至7.0 cm。在二维和三维中识别出了多种微观特征，包括薄帽纤维粥样斑块、钙、巨噬细胞、胆固醇晶体、裸支架支柱以及伴有内膜增生的支架。OFDI操作无并发症发生。
我们的结果表明，OFDI是一种对患者长冠状动脉段微观结构成像的可行方法。鉴于其能够以实用的方式提供微观信息，该技术可能有助于在体内研究人类冠状动脉病理生理学，并作为指导冠状动脉疾病管理的临床工具。
