Muller James, Madder Ryan
Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.
Spectrum Health, Grand Rapids, MI, United States.
Front Cardiovasc Med. 2020 Jun 4;7:90. doi: 10.3389/fcvm.2020.00090. eCollection 2020.
A combination optical coherence tomography and near-infrared spectroscopy (OCT-NIRS) coronary imaging system is being developed to improve the care of coronary patients. While stenting has improved, complications continue to occur at the stented site and new events are caused by unrecognized vulnerable plaques. An OCT-NIRS device has potential to improve secondary prevention by optimizing stenting and by identifying vulnerable patients and vulnerable plaques. OCT is already in widespread use world-wide to optimize coronary artery stenting. It provides automated lumen detection and can identify features of coronary plaques not accurately identified by angiography or intravascular ultrasound. The ILUMIEN IV study, to be completed in 2022, will determine if OCT-guided stenting will yield better clinical outcomes than angiographic guidance alone. While the superb spatial resolution of OCT enables the identification of many plaque structural features, the detection by OCT of lipids, an important component of vulnerable plaques, is limited by suboptimal specificity and interobserver agreement. In contrast, NIRS has been extensively validated for lipid-rich plaque detection against the gold-standard of histology and is the only FDA-approved method to identify coronary lipids. Studies in patients have demonstrated that NIRS detects lipid in culprit lesions causing coronary events. In 2019, the positive results of the prospective Lipid-Rich Plaque Study led to FDA approval of NIRS for detection of high-risk plaques and patients. The complementarity of OCT for plaque structure and NIRS for plaque composition led to the sequential performance of NIRS and OCT imaging in patients. NIRS identified lipid while OCT determined the thickness of the cap over the lipid pool. The positive results obtained with OCT and NIRS imaging led to development of a prototype combined OCT-NIRS catheter that can provide co-registered OCT and NIRS data in a single pullback. The data will provide structural and chemical information likely to improve stenting and deliver more accurate identification of vulnerable plaques and vulnerable patients. More precise diagnosis will then lead to OCT-NIRS guided treatment trials to improve secondary prevention. Success in secondary prevention will then facilitate development of improved primary prevention with invasive imaging and effective treatment of patients identified by non-invasive methods.
一种结合光学相干断层扫描和近红外光谱技术（OCT-NIRS）的冠状动脉成像系统正在研发中，以改善冠心病患者的治疗。尽管支架置入术已有改进，但支架置入部位仍会出现并发症，且新的事件是由未被识别的易损斑块引起的。OCT-NIRS设备有潜力通过优化支架置入术以及识别易损患者和易损斑块来改善二级预防。OCT已在全球广泛用于优化冠状动脉支架置入术。它能自动检测管腔，并可识别血管造影或血管内超声无法准确识别的冠状动脉斑块特征。将于2022年完成的ILUMIEN IV研究将确定OCT引导下的支架置入术是否比单纯血管造影引导能产生更好的临床结果。虽然OCT卓越的空间分辨率能够识别许多斑块结构特征，但OCT对脂质（易损斑块的一个重要成分）的检测受限于次优的特异性和观察者间的一致性。相比之下，NIRS已针对富含脂质斑块的检测与组织学金标准进行了广泛验证，并且是唯一获得美国食品药品监督管理局（FDA）批准用于识别冠状动脉脂质的方法。对患者的研究表明，NIRS能检测出导致冠状动脉事件的罪犯病变中的脂质。2019年，前瞻性富含脂质斑块研究的阳性结果促使FDA批准NIRS用于检测高危斑块和患者。OCT对斑块结构和NIRS对斑块成分的互补性导致了在患者中依次进行NIRS和OCT成像。NIRS识别脂质而OCT确定脂质池上方纤维帽的厚度。OCT和NIRS成像获得的阳性结果促使研发出一种原型联合OCT-NIRS导管，该导管可在单次回撤中提供配准的OCT和NIRS数据。这些数据将提供可能改善支架置入术并更准确识别易损斑块和易损患者的结构和化学信息。更精确的诊断随后将引发OCT-NIRS引导的治疗试验以改善二级预防。二级预防的成功将促进改进一级预防的发展，包括采用有创成像以及对通过无创方法识别出的患者进行有效治疗。
