Rougé A, Wintzer-Wehekind J, Milouchi S, Abdellaoui M, Faurie B, Monségu J
Institut cardiovasculaire, groupe hospitalier mutualiste, 8, rue Dr-Calmette, 38000 Grenoble, France.
Service de cardiologie, hôpital régional de Médenine, 4131 Médenine, Tunisie.
Ann Cardiol Angeiol (Paris). 2017 Dec;66(6):405-410. doi: 10.1016/j.ancard.2017.10.005. Epub 2017 Oct 31.
Acute coronary syndrome (ACS) remains a major cause of mortality and morbidity in the world, although it has considerably decreased through technical and pharmacological advances. The physiopathological approach of the ACS has progressed considerably in recent years thanks to the anatomopathological work and the data of the endocoronary imaging, in particular of the endovascular ultrasound (IVUS). Plaque rupture is the most common cause of ACS, however OCT (optical coherence tomography) studies have shown that surface plaque erosion was more common than thought. The use of OCT in the ACS may prove to be a valuable diagnostic aid: study of the culpable lesion, spontaneous coronary dissection or intramural spontaneous hematoma, stent thrombosis; from a therapeutic point of view: reduction of the risk of stent malapposition, additional technique, delayed stenting, implantation of a bioresorbable stent, medical treatment of ACS without stenting. Endocoronary imaging, especially OCT, will of course never be systematic as treatment of ACS, but providing excellent value for both diagnosis and treatment, it must be an integral part of the therapeutic arsenal available in cathlab.
急性冠状动脉综合征（ACS）仍是全球主要的死亡和发病原因，尽管通过技术和药理学进展其发生率已大幅下降。近年来，由于解剖病理学研究以及冠状动脉内成像数据，特别是血管内超声（IVUS）数据，ACS的病理生理学研究取得了显著进展。斑块破裂是ACS最常见的原因，然而光学相干断层扫描（OCT）研究表明，表面斑块侵蚀比人们想象的更为常见。在ACS中使用OCT可能被证明是一种有价值的诊断辅助手段：用于研究罪犯病变、自发性冠状动脉夹层或壁内自发性血肿、支架血栓形成；从治疗角度来看：降低支架贴壁不良的风险、辅助技术、延迟支架置入、生物可吸收支架植入、无支架置入的ACS药物治疗。冠状动脉内成像，尤其是OCT，当然永远不会作为ACS治疗的常规手段，但因其在诊断和治疗方面都具有卓越价值，它必须成为心导管室可用治疗手段不可或缺的一部分。
