Sarwar Maruf, Adedokun Stephen, Narayanan Mahesh Anantha
Department of Cardiovascular Sciences, White River Health, Batesville, AR, USA.
Division of Cardiology, University of Tennessee at Memphis, TN, USA.
J Geriatr Cardiol. 2024 Jan 28;21(1):104-129. doi: 10.26599/1671-5411.2024.01.001.
Coronary angiography has long been the standard for coronary imaging, but it has limitations in assessing vessel wall anatomy and guiding percutaneous coronary intervention (PCI). Intracoronary imaging techniques like intravascular ultrasound (IVUS) and optical coherence tomography (OCT) can overcome these limitations. IVUS uses ultrasound and OCT uses near-infrared light to visualize coronary pathology in unique ways due to differences in temporal and spatial resolution. These techniques have evolved to offer clinical utility in plaque characterization and vessel assessment during PCI. Meta-analyses and adjusted observational studies suggest that both IVUS and OCT-guided PCI correlate with reduced cardiovascular risks compared to angiographic guidance alone. While IVUS demonstrates consistent clinical outcome benefits, OCT evidence is less robust. IVUS has progressed from early motion detection to high-resolution systems, with smaller compatible catheters. OCT utilizes near infrared light to achieve unparalleled resolutions, but requires temporary blood clearance for optimal imaging. Enhanced visualization and guidance make IVUS and OCT well-suited for higher risk PCI in patients with diabetes and chronic kidney disease by allowing detailed visualization of complex lesions and ensuring optimal stent deployment and positioning in PCI for patients with type 2 diabetes and chronic kidney disease, improving outcomes. IVUS and recent advancements in zero- and low-contrast OCT techniques can reduce nephrotoxic contrast exposure, thus helping to minimize PCI complications in these high-risk patient groups. IVUS and OCT provide valuable insights into coronary pathophysiology and guide interventions precisely compared to angiography alone. Both have comparable clinical outcomes, emphasizing the need for tailored imaging choices based on clinical scenarios. Continued refinement and integration of intravascular imaging will likely play a pivotal role in optimizing coronary interventions and outcomes. This systematic review aims to delve into the nuances of IVUS and OCT, highlighting their strengths and limitations as PCI adjuncts.
冠状动脉造影长期以来一直是冠状动脉成像的标准，但在评估血管壁解剖结构和指导经皮冠状动脉介入治疗（PCI）方面存在局限性。血管内超声（IVUS）和光学相干断层扫描（OCT）等冠状动脉内成像技术可以克服这些局限性。IVUS使用超声波，而OCT使用近红外光，由于时间和空间分辨率的差异，它们以独特的方式可视化冠状动脉病变。这些技术已经发展到在PCI期间的斑块特征分析和血管评估中具有临床实用性。荟萃分析和校正观察性研究表明，与单纯血管造影引导相比，IVUS和OCT引导的PCI均与降低心血管风险相关。虽然IVUS显示出一致的临床结局益处，但OCT的证据则不那么确凿。IVUS已从早期的运动检测发展到高分辨率系统，兼容的导管更小。OCT利用近红外光实现无与伦比的分辨率，但需要临时清除血液以获得最佳成像效果。增强的可视化和引导功能使IVUS和OCT非常适合糖尿病和慢性肾病患者的高风险PCI，通过详细可视化复杂病变并确保2型糖尿病和慢性肾病患者PCI中的支架最佳部署和定位，改善结局。IVUS以及零造影剂和低造影剂OCT技术的最新进展可以减少肾毒性造影剂暴露，从而有助于将这些高风险患者群体中的PCI并发症降至最低。与单独的血管造影相比，IVUS和OCT为冠状动脉病理生理学提供了有价值的见解，并精确地指导干预措施。两者具有相当的临床结局，强调需要根据临床情况进行量身定制的成像选择。血管内成像的持续改进和整合可能在优化冠状动脉介入治疗和结局方面发挥关键作用。本系统评价旨在深入探讨IVUS和OCT的细微差别，突出它们作为PCI辅助手段的优势和局限性。
