Department of Interventional Cardiology, Thoraxcenter, Erasmus, Rotterdam, The Netherlands.
J Cardiovasc Med (Hagerstown). 2011 Aug;12(8):562-70. doi: 10.2459/JCM.0b013e3283492b5a.
Since the introduction of intravascular, catheter-based invasive imaging and diagnostic tools in the catheterization laboratories two decades ago, the functional assessment of angiographically moderate or ambiguous lesions by fractional flow reserve measurements represents the established standard of care today. Likewise, intravascular ultrasound (IVUS) is widely accepted to guide treatment strategy in complex lesions, such as long or left main stem lesions. Developments are driven by the clinical interest to optimize treatment, prevent periprocedural complications, understand treatment failure and understand progression of atherosclerosis. As a result, a variety of devices are now clinically available that enable detection and monitoring of specific plaque features over time, such as the presence of necrotic core by IVUS-VH, a lipid-core plaque by near infrared (NIR) spectroscopy or a thin fibrous cap atheroma by optical coherence tomography (OCT). As the physical boundaries for both light and sound are different, these imaging technologies offer different advantages and limitations. Light-based technologies offer unparalleled high image resolution (OCT) or unparalleled high sensitivity and specificity for distinct plaque components (NIR spectroscopy), whereas conventional IVUS offers a much better tissue penetration. From a clinical perspective, both types of information are valuable. Ideally, this information should easily and in real time be available in the catheterization laboratory, consisting of co-registered datasets gained during a single catheter pullback. On this background, a combined NIR spectroscopy and IVUS catheter has recently been introduced for clinical use. The article discusses the potential and limitations of these different technologies. They may allow advanced coronary plaque diagnosis in a fast, accurate, reliable, user- and patient-friendly manner and, as such, can help to improve clinical practice today and therapeutic options in the future.
自二十年前介入导管室引入血管内、基于导管的侵袭性成像和诊断工具以来，通过血流储备分数测量对血管造影中度或模棱两可病变的功能评估代表了当今既定的护理标准。同样，血管内超声 (IVUS) 广泛用于指导复杂病变（如长病变或左主干病变）的治疗策略。这些发展是由优化治疗、预防围手术期并发症、了解治疗失败和了解动脉粥样硬化进展的临床兴趣驱动的。因此，现在有多种设备在临床上可用于检测和监测特定斑块特征随时间的变化，例如通过 IVUS-VH 检测坏死核心的存在、通过近红外 (NIR) 光谱检测脂质核心斑块或通过光学相干断层扫描 (OCT) 检测薄纤维帽粥样斑块。由于光和声的物理边界不同，这些成像技术具有不同的优势和局限性。基于光的技术提供无与伦比的高图像分辨率（OCT）或对独特斑块成分的无与伦比的高灵敏度和特异性（NIR 光谱学），而传统的 IVUS 提供更好的组织穿透性。从临床的角度来看，这两种类型的信息都很有价值。理想情况下，这些信息应该在导管室中以简单和实时的方式提供，这些信息由单次导管回撤过程中获得的配准数据集组成。在此背景下，最近已经推出了一种结合近红外光谱和 IVUS 的导管用于临床应用。本文讨论了这些不同技术的潜力和局限性。它们可以以快速、准确、可靠、用户友好和患者友好的方式实现先进的冠状动脉斑块诊断，从而帮助改善今天的临床实践和未来的治疗选择。
