Batty Jonathan A, Subba Shristy, Luke Peter, Gigi Li Wing Chi, Sinclair Hannah, Kunadian Vijay
Institute of Cellular Medicine, Newcastle University, 3rd Floor, William Leech Building, Newcastle Upon Tyne, NE2 4HH, UK.
Freeman Hospital, Newcastle Upon Tyne NHS Foundation Trust, Newcastle Upon Tyne, NE7 7DN, UK.
Curr Cardiol Rep. 2016 Mar;18(3):28. doi: 10.1007/s11886-016-0705-1.
Coronary artery disease is the result of atherosclerotic changes to the coronary arterial wall, comprising endothelial dysfunction, vascular inflammation and deposition of lipid-rich macrophage foam cells. Certain high-risk atherosclerotic plaques are vulnerable to disruption, leading to rupture, thrombosis and the clinical sequelae of acute coronary syndrome. Though recognised as the gold standard for evaluating the presence, distribution and severity of atherosclerotic lesions, invasive coronary angiography is incapable of identifying non-stenotic, vulnerable plaques that are responsible for adverse cardiovascular events. The recognition of such limitations has impelled the development of intracoronary imaging technologies, including intravascular ultrasound, optical coherence tomography and near-infrared spectroscopy, which enable the detailed evaluation of the coronary wall and atherosclerotic plaques in clinical practice. This review discusses the present status of invasive imaging technologies; summarises up-to-date, evidence-based clinical guidelines; and addresses questions that remain unanswered with regard to the future of intracoronary plaque imaging.
冠状动脉疾病是冠状动脉壁发生动脉粥样硬化改变的结果，包括内皮功能障碍、血管炎症以及富含脂质的巨噬细胞泡沫细胞的沉积。某些高危动脉粥样硬化斑块易发生破裂，导致急性冠状动脉综合征的临床后遗症，如破裂、血栓形成等。尽管有创冠状动脉造影被公认为评估动脉粥样硬化病变的存在、分布和严重程度的金标准，但它无法识别导致不良心血管事件的非狭窄性易损斑块。对这些局限性的认识推动了冠状动脉内成像技术的发展，包括血管内超声、光学相干断层扫描和近红外光谱，这些技术能够在临床实践中对冠状动脉壁和动脉粥样硬化斑块进行详细评估。本综述讨论了有创成像技术的现状；总结了最新的、基于证据的临床指南；并探讨了冠状动脉斑块成像未来仍未得到解答的问题。
