Ndao Serigne C T, Amabile Nicolas
Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Massy, France.
Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Massy, France.
Ann Cardiol Angeiol (Paris). 2025 Sep;74(4):101916. doi: 10.1016/j.ancard.2025.101916. Epub 2025 Aug 23.
Coronary artery disease remains the leading cause of mortality among women, despite a persistent underestimation of its clinical impact. Intracoronary imaging techniques (ICI), such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT), have emerged as valuable tools to complement angiography, especially in women, whose pathophysiological mechanisms are often atypical.
To analyse current data on the use of ICI in women and highlight its benefits, limitations, and sex-specific considerations.
Narrative review of recent literature, including observational studies, post-hoc analyses of randomized trials, and registries focusing on IVUS and OCT use in women.
Women tend to have smaller coronary arteries, less extensive atherosclerotic disease, and distinct plaque composition, with a predominance of erosions over ruptures. These characteristics are poorly assessed by angiography alone, reinforcing the value of ICI, particularly in cases of MINOCA and spontaneous coronary artery dissection (SCAD). Despite demonstrated clinical benefits, ICI remains underused in women, with lower penetration into routine practice and underrepresentation in clinical trials. Complications related to intracoronary imaging are rare and comparable between genders, if precautions specific to female anatomy are observed.
ICI represents a significant yet underutilized opportunity to improve cardiovascular outcomes in women. Better integration of this technology into diagnostic and therapeutic strategies, combined with more gender-specific research, is essential to reduce persistent disparities in care.
尽管冠心病的临床影响一直被低估，但它仍是女性死亡的主要原因。冠状动脉内成像技术（ICI），如血管内超声（IVUS）和光学相干断层扫描（OCT），已成为补充血管造影的重要工具，尤其是对于病理生理机制往往不典型的女性。
分析目前关于女性使用ICI的数据，并强调其益处、局限性以及性别特异性考量。
对近期文献进行叙述性综述，包括观察性研究、随机试验的事后分析以及关注女性使用IVUS和OCT的注册研究。
女性往往冠状动脉较小，动脉粥样硬化疾病范围较小，斑块成分不同，侵蚀性斑块多于破裂性斑块。仅靠血管造影很难评估这些特征，这凸显了ICI的价值，特别是在心肌梗死疑似非阻塞性冠状动脉疾病（MINOCA）和自发性冠状动脉夹层（SCAD）的病例中。尽管已证明ICI具有临床益处，但在女性中其使用仍然不足，在常规实践中的渗透率较低，在临床试验中的代表性也不足。如果遵循针对女性解剖结构的预防措施，与冠状动脉内成像相关的并发症很少见，且两性之间相当。
ICI是改善女性心血管结局的一个重要但未充分利用的机会。将该技术更好地整合到诊断和治疗策略中，再结合更多针对性别的研究，对于减少持续存在的护理差异至关重要。
