体内钙检测的比较：光学相干断层扫描、血管内超声和血管造影。
In Vivo Calcium Detection by Comparing Optical Coherence Tomography, Intravascular Ultrasound, and Angiography.
机构信息
Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York; Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Clinical Trials Center, Cardiovascular Research Foundation, New York, New York.
出版信息
JACC Cardiovasc Imaging. 2017 Aug;10(8):869-879. doi: 10.1016/j.jcmg.2017.05.014.
OBJECTIVES
The aim of this study was to evaluate optical coherence tomography (OCT) and intravascular ultrasound (IVUS) versus coronary angiography in the assessment of target lesion calcification and its effect on stent expansion.
BACKGROUND
IVUS is more sensitive than angiography in the detection of coronary artery calcium, but the relationship among IVUS, OCT, and angiography has not been studied.
METHODS
Overall, 440 lesions (440 patients with stable angina) underwent OCT- and IVUS-guided stent implantation. Coronary calcification was evaluated using: 1) angiography; 2) IVUS (maximum calcium angle and the surface pattern); and 3) OCT (mean and maximum calcium angle, calcium length, and maximum calcium thickness).
RESULTS
Median patient age was 66 years, and 82.5% were men. Among 440 lesions, calcium was detected by angiography in 40.2%, IVUS in 82.7%, and OCT in 76.8%. The maximum calcium angle, maximum calcium thickness, and calcium length by OCT or IVUS increased in relation to the increasing severity of angiographically visible calcium. In 13.2% of lesions with IVUS-detected calcium, calcium was either not visible or was underestimated (>90° smaller maximum arc) by OCT mostly due to superficial OCT plaque attenuation. In 21.6% of lesions with IVUS calcium angle >180°, angiography did not detect any calcium; these lesions had thinner and shorter calcium deposits as assessed using OCT, and final minimum stent area was larger compared to those with angiographically visible calcium. In lesions with thinner calcium deposits by OCT, IVUS detected a smooth surface with reverberations whereas thick calcium deposits were associated with an irregular surface without reverberations.
CONCLUSIONS
Angiographic detection of target lesion coronary calcium (compared to intravascular imaging) has not changed in the past 2 decades, and angiographically invisible calcium (only detectable by IVUS or OCT) did not appear to inhibit stent expansion.
目的
本研究旨在评估光学相干断层扫描（OCT）和血管内超声（IVUS）与冠状动脉造影在评估目标病变钙化及其对支架扩张影响方面的作用。
背景
IVUS 在检测冠状动脉钙化方面比血管造影更敏感，但 IVUS、OCT 和血管造影之间的关系尚未得到研究。
方法
共有 440 处病变（440 例稳定型心绞痛患者）接受了 OCT 和 IVUS 指导下的支架植入术。使用以下方法评估冠状动脉钙化：1）血管造影；2）IVUS（最大钙角和表面形态）；3）OCT（平均和最大钙角、钙长度和最大钙厚度）。
结果
中位患者年龄为 66 岁，82.5%为男性。在 440 处病变中，40.2%通过血管造影、82.7%通过 IVUS、76.8%通过 OCT 检测到钙。OCT 或 IVUS 检测到的最大钙角、最大钙厚度和钙长度随血管造影可见钙严重程度的增加而增加。在 13.2%的 IVUS 检测到钙的病变中，OCT 要么没有检测到钙，要么（最大弧形角度小>90°）低估了钙，这主要是由于 OCT 斑块衰减导致的浅层 OCT 斑块衰减。在 21.6%的 IVUS 钙角>180°的病变中，血管造影未检测到任何钙；这些病变的钙沉积较薄且较短，OCT 评估的最终最小支架面积也大于血管造影可见钙的病变。在 OCT 检测到的钙沉积较薄的病变中，IVUS 检测到的是光滑表面有回声，而较厚的钙沉积则与无回声的不规则表面相关。
结论
过去 20 年来，目标病变冠状动脉钙的血管造影检测（与血管内成像相比）并未改变，而血管造影不可见的钙（仅可通过 IVUS 或 OCT 检测）似乎并未抑制支架扩张。
Zotero 插件