Wolfrum Mathias, De Maria Giovanni Luigi, Banning Adrian P
a Oxford Heart Centre , Oxford University Hospitals NHS Foundation Trust , Oxford , United Kingdom.
b Department of Internal Medicine , Cardiology and Angiology, Magdeburg University , Magdeburg , Germany.
Expert Rev Cardiovasc Ther. 2017 Sep;15(9):705-713. doi: 10.1080/14779072.2017.1362982. Epub 2017 Aug 9.
Cardiovascular disease remains the most common cause of death worldwide. Enormous progress in the technology and applicability of percutaneous techniques to treat obstructive coronary heart disease has been made, and the number of percutaneous coronary interventions (PCI) is increasing. Coronary bifurcations are involved in a substantial number of PCIs and despite recent advances, bifurcation PCI remains a challenge in terms of immediate success and long-term outcome. Angiography has a limited capacity for showing important features of the 3 dimensional coronary vessel anatomy, position of stent struts and exact wire positions and is therefore suboptimal for guiding bifurcation PCI. Intracoronary optical coherence tomography (OCT) provides high resolution and the information gained during PCI is unprecedented compared with angiography guidance and intravascular ultrasound. Areas covered: This review will provide an overview of the use of OCT to guide bifurcation-PCI. Expert commentary: OCT is a promising guide for bifurcation-PCI at each individual step: from planning the strategy (provisional versus two-stent strategy), to guidance during PCI, and finally checking the interventional result. Until dedicated randomized trails are complete, we recommend OCT guidance for interventions in complex coronary bifurcation disease and for imaging when unexpected procedural events occur.
心血管疾病仍然是全球最常见的死因。在经皮技术治疗阻塞性冠心病的技术和适用性方面已经取得了巨大进展，经皮冠状动脉介入治疗（PCI）的数量也在不断增加。大量的PCI涉及冠状动脉分叉，尽管最近有了进展，但分叉病变的PCI在即刻成功率和长期预后方面仍然是一个挑战。血管造影在显示三维冠状动脉血管解剖结构、支架支柱位置和确切导丝位置等重要特征方面能力有限，因此对于指导分叉病变的PCI并非最佳选择。冠状动脉内光学相干断层扫描（OCT）提供高分辨率，与血管造影指导和血管内超声相比，PCI过程中获得的信息是前所未有的。涵盖领域：本综述将概述OCT在指导分叉病变PCI方面的应用。专家评论：OCT在分叉病变PCI的各个步骤都是一个有前景的指导：从策略规划（临时策略与双支架策略），到PCI过程中的指导，最后检查介入结果。在专门的随机试验完成之前，我们建议在复杂冠状动脉分叉病变的介入治疗以及出现意外手术事件时进行成像时采用OCT指导。
