Michail Michael, Serruys Patrick W, Stettler Rodrigue, Crake Tom, Torii Ryo, Tenekecioglu Erhan, Zeng Yaping, Onuma Yoshinobu, Mathur Anthony, Bourantas Christos V
Barts Heart Centre, Barts Health NHS Trust, London, UK.
Faculty of Medicine, National Heart & Lung Institute, Imperial College London, UK.
Eur Heart J Cardiovasc Imaging. 2017 Jun 1;18(6):613-620. doi: 10.1093/ehjci/jew330.
Coronary artery disease remains the leading cause of death in the developed world. Over recent years, research has been focused on the development of diagnostic intravascular imaging techniques that enable assessment of plaque composition and morphology, and allow identification of vulnerable, high-risk lesions. Nevertheless recent studies of coronary atherosclerosis have shown that invasive modalities have a limited accuracy in detecting lesions that will progress and cause events, whilst histology-based studies also highlighted the limitations of invasive imaging in assessing plaque characteristics. To overcome these drawbacks, multimodality imaging has been proposed. Although it is apparent that coronary imaging with two or three imaging modalities is time consuming and is associated with a risk of complications, evidence from small clinical studies demonstrated that it provides incremental information about plaque pathology and biology and underscored the need to develop dual-probe hybrid imaging catheters that would enable complete and comprehensive assessment of plaque morphology. This paper reviews the current clinical evidence that supports the use of multimodality intravascular imaging in the study of atherosclerosis, summarizes the key findings of the first invasive imaging studies that utilize hybrid dual-probe catheters, and discusses the limitations of combined intravascular imaging that restrict its broad application in both the clinical and research arena.
冠状动脉疾病仍然是发达国家的主要死因。近年来，研究集中在开发诊断性血管内成像技术，这些技术能够评估斑块成分和形态，并识别易损的高危病变。然而，最近关于冠状动脉粥样硬化的研究表明，侵入性检查手段在检测会进展并导致事件发生的病变方面准确性有限，而基于组织学的研究也突出了侵入性成像在评估斑块特征方面的局限性。为克服这些缺点，人们提出了多模态成像。尽管显然使用两种或三种成像模态进行冠状动脉成像既耗时又有并发症风险，但小型临床研究的证据表明，它能提供有关斑块病理学和生物学的增量信息，并强调了开发双探头混合成像导管的必要性，这种导管能够对斑块形态进行完整和全面的评估。本文回顾了支持在动脉粥样硬化研究中使用多模态血管内成像的当前临床证据，总结了利用混合双探头导管的首批侵入性成像研究的关键发现，并讨论了限制其在临床和研究领域广泛应用的联合血管内成像的局限性。
