Department of Cardiology, Radboudumc, Nijmegen, the Netherlands.
Department of Cardiology, Haaglanden Medisch Centrum, the Hague, the Netherlands.
Trends Cardiovasc Med. 2023 Feb;33(2):92-106. doi: 10.1016/j.tcm.2021.10.009. Epub 2021 Oct 30.
Angiography alone is the most commonly used imaging modality for guidance of percutaneous coronary interventions. Angiography is limited, however, by several factors, including that it only portrays a low resolution, two-dimensional outline of the lumen and does not inform on plaque composition and functional stenosis severity. Optical coherence tomography (OCT) is an intracoronary imaging technique that has superior spatial resolution compared to all other imaging modalities. High-resolution imaging of the vascular wall enables precise measurement of vessel wall and luminal dimensions, more accurately informing about the anatomic severity of epicardial stenoses, and also provides input for computational models to assess functional severity. The very high-resolution images also permit plaque characterization that may be informative for prognostication. Moreover, periprocedural imaging provides valuable information to guide lesion preparation, stent implantation and to evaluate acute stent complications for which iterative treatment might reduce the occurrence of major adverse stent events. As such, OCT represent a potential future all-in-one tool that provides the data necessary to establish the indications, procedural planning and optimization, and final evaluation of percutaneous coronary revascularization.
血管造影术是经皮冠状动脉介入治疗最常用的影像学引导方法。然而，血管造影术受到多种因素的限制，包括其仅能显示管腔的低分辨率二维轮廓，并不能提供斑块成分和功能狭窄严重程度的信息。光学相干断层扫描（OCT）是一种冠状动脉内成像技术，与其他所有成像方式相比，具有更高的空间分辨率。对血管壁的高分辨率成像能够精确测量血管壁和管腔的尺寸，更准确地了解心外膜狭窄的解剖严重程度，并为计算模型提供输入以评估功能严重程度。非常高的分辨率图像还允许进行斑块特征分析，这可能对预后有提示作用。此外，术中介入成像提供了有价值的信息，可用于指导病变准备、支架植入，并评估急性支架并发症，反复治疗可能会降低主要不良支架事件的发生。因此，OCT 代表了一种潜在的未来全能工具，它提供了建立经皮冠状动脉血运重建适应证、手术规划和优化以及最终评估所需的数据。
