Xenogiannis Iosif, Pavlidis Antonis N, Kaier Thomas E, Rigopoulos Angelos G, Karamasis Grigoris V, Triantafyllis Andreas S, Vardas Panos, Brilakis Emmanouil S, Kalogeropoulos Andreas S
Department of Cardiology, Mitera General Hospital, Hygeia HealthCare Group, Athens, Greece.
Second Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.
Front Cardiovasc Med. 2023 Sep 11;10:1199067. doi: 10.3389/fcvm.2023.1199067. eCollection 2023.
Chronic total occlusions (CTOs) represent the most complex subset of coronary artery disease and therefore careful planning of CTO percutaneous coronary recanalization (PCI) strategy is of paramount importance aiming to achieve procedural success, and improve patient's safety and post CTO PCI outcomes. Intravascular imaging has an essential role in facilitating CTO PCΙ. First, intravascular ultrasound (IVUS), due to its higher penetration depth compared to optical coherence tomography (OCT), and the additional capacity of real-time imaging without need for contrast injection is considered the preferred imaging modality for CTO PCI. Secondly, IVUS can be used to resolve proximal cap ambiguity, facilitate wire re-entry when dissection and re-entry strategies are applied and most importantly to guide stent deployment and optimization post implantation. The role of OCT during CTO PCI is currently limited to stent sizing and optimization, however, due to its high spatial resolution, OCT is ideal for detecting stent edge dissections and strut malapposition. In this review, we describe the use of intravascular imaging for lesion crossing, plaque characterization and wire tracking, extra- or intra-plaque, and stent sizing and optimization during CTO PCI and summarize the findings of the major studies in this field.
慢性完全闭塞病变（CTO）是冠状动脉疾病中最复杂的一类，因此，精心规划CTO经皮冠状动脉再通（PCI）策略对于实现手术成功、提高患者安全性及CTO PCI术后效果至关重要。血管内成像在CTO PCI中起着至关重要的作用。首先，血管内超声（IVUS）因其穿透深度高于光学相干断层扫描（OCT），且具备无需注射造影剂即可进行实时成像的额外能力，被认为是CTO PCI的首选成像方式。其次，IVUS可用于解决近端帽模糊问题，在应用夹层和再入策略时便于导丝再入，最重要的是可指导支架植入及植入后优化。然而，OCT在CTO PCI中的作用目前仅限于支架尺寸确定和优化，不过，由于其高空间分辨率，OCT非常适合检测支架边缘夹层和支柱贴壁不良。在本综述中，我们描述了血管内成像在CTO PCI期间用于病变穿过、斑块特征分析和导丝追踪（斑块外或斑块内）以及支架尺寸确定和优化的应用，并总结了该领域主要研究的结果。
