Department of Cardiology, Bern University Hospital, Bern 3010, Switzerland.
Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Eur Heart J. 2016 Feb 7;37(6):524-35a-c. doi: 10.1093/eurheartj/ehv642. Epub 2015 Dec 11.
While coronary atherosclerosis is a leading cause of mortality, evaluation of coronary lesions was previously limited to either indirect angiographic assessment of the lumen silhouette or post mortem investigations. Intracoronary (IC) imaging modalities have been developed that allow for visualization and characterization of coronary atheroma in living patients. Used alone or in combination, these modalities have enhanced our understanding of pathobiological mechanisms of atherosclerosis, identified factors responsible for disease progression, and documented the ability of various medications to reverse the processes of plaque growth and destabilization. These methodologies have established a link between in vivo plaque characteristics and subsequent coronary events, thereby improving individual risk stratification, paving the way for risk-tailored systemic therapies and raising the option for pre-emptive interventions. Moreover, IC imaging is increasingly used during coronary interventions to support therapeutic decision-making in angiographically inconclusive disease, guide and optimize procedural results in selected lesion and patient subsets, and unravel mechanisms underlying stent failure. This review aims to summarize current evidence regarding the role of IC imaging for diagnosis and risk stratification of coronary atherosclerosis, and to describe its clinical role for guiding percutaneous coronary interventions. Future perspectives for in-depth plaque characterization using novel techniques and multimodality imaging approaches are also discussed.
虽然冠状动脉粥样硬化是导致死亡的主要原因，但以前对冠状动脉病变的评估仅限于管腔轮廓的间接血管造影评估或死后调查。已经开发出了冠状动脉（IC）成像方式，可以在活体患者中可视化和表征冠状动脉粥样硬化斑块。这些方式单独或联合使用，增强了我们对动脉粥样硬化病理生物学机制的理解，确定了导致疾病进展的因素，并记录了各种药物逆转斑块生长和不稳定过程的能力。这些方法将体内斑块特征与随后的冠状动脉事件联系起来，从而改善个体风险分层，为量身定制的系统治疗铺平道路，并为抢先干预提供选择。此外，在冠状动脉介入治疗中越来越多地使用 IC 成像来支持在血管造影不确定疾病中的治疗决策，指导和优化选定病变和患者亚组的程序结果，并揭示支架失败的机制。本综述旨在总结 IC 成像在冠状动脉粥样硬化的诊断和风险分层中的作用的现有证据，并描述其在指导经皮冠状动脉介入治疗中的临床作用。还讨论了使用新型技术和多模态成像方法进行深入斑块特征描述的未来展望。
