König A, Klauss V
Abteilung Kardiologie, Medizinische Klinik und Poliklinik-Campus Innenstadt, Ludwig-Maximilians-Universität, Ziemssenstrasse 1, Munich, Germany.
Herz. 2011 Aug;36(5):402-9. doi: 10.1007/s00059-011-3485-9.
Coronary atherosclerosis including acute coronary syndrome (ACS) is the leading cause of death in the western world and in the majority of patients is caused by plaque rupture in flow-limiting and non-flow-limiting angiographically intermediate stenoses. Histopathologic analyses have shown the relationship of plaque composition to acute clinical events and therefore to the vulnerability of coronary lesions. Knowledge of remodeling processes of the coronary artery has focused interest on non-flow-limiting lesions of the coronary tree. Intravascular ultrasound (IVUS) can demonstrate discrepancies between the extent of coronary atherosclerosis and angiographic imaging by in vivo plaque imaging. In addition the spectral analysis of IVUS-derived radiofrequency (RF) data enables more precise analysis of the plaque composition and plaque type.As IVUS is best able to assess stent underexpansion and malapposition the guidance of catheter-based coronary interventions plays a major role in angiographically unclear lesions even in the drug-eluting stent era. In the field of percutaneous coronary interventions (PCI) IVUS can influence the therapy and therefore optimize the stratification of patients.In terms of secondary prevention it is of great clinical importance to detect progression of coronary artery disease and moreover to predict coronary lesions with significant progression up to ACS. Coronary angiography and clinical parameters are poor surrogates to predict future events in a broad cohort of patients after PCI. In addition non-invasive imaging fails to identify coronary plaques with potential rupture and subsequent ACS. This highlights the need to identify potentially high risk lesions. However, prospective studies with IVUS-RF imaging to detect lesions that are considered to be prone to rupture showed no evidence for catheter-based invasive treatment of a non-flow-limiting high risk plaque.In the future the integrated combination of multiple technologies (e.g. IVUS-RF and optical coherence tomography) can further improve the accuracy of the analysis of high risk lesions.
冠状动脉粥样硬化，包括急性冠状动脉综合征（ACS），是西方世界的主要死因，在大多数患者中，是由血流限制和非血流限制的血管造影中度狭窄处的斑块破裂引起的。组织病理学分析显示了斑块成分与急性临床事件的关系，因此也显示了与冠状动脉病变易损性的关系。对冠状动脉重塑过程的认识使人们将兴趣集中在冠状动脉树的非血流限制病变上。血管内超声（IVUS）可以通过体内斑块成像显示冠状动脉粥样硬化程度与血管造影成像之间的差异。此外，IVUS衍生的射频（RF）数据的频谱分析能够更精确地分析斑块成分和斑块类型。由于IVUS最能评估支架扩张不足和贴壁不良，即使在药物洗脱支架时代，基于导管的冠状动脉介入治疗的指导在血管造影不明确的病变中也起着重要作用。在经皮冠状动脉介入治疗（PCI）领域，IVUS可以影响治疗，从而优化患者分层。在二级预防方面，检测冠状动脉疾病的进展并预测直至ACS的显著进展的冠状动脉病变具有重要的临床意义。冠状动脉造影和临床参数在预测PCI后广大患者群体未来事件方面是较差的替代指标。此外，非侵入性成像无法识别具有潜在破裂和随后发生ACS风险的冠状动脉斑块。这突出了识别潜在高风险病变的必要性。然而，使用IVUS-RF成像进行的前瞻性研究，以检测被认为易于破裂的病变，没有证据支持对非血流限制的高风险斑块进行基于导管的侵入性治疗。未来，多种技术（如IVUS-RF和光学相干断层扫描）的综合结合可以进一步提高高风险病变分析的准确性。
