OCTIVUS检测技术在冠脉介入诊治中的应用.ppt

* 组织脱垂 支架内血栓 支架置入后随访 OCT优于IVUS 支架早期内膜愈合 晚期贴壁不良 支架内再狭窄 支架内血栓 支架内新生内膜组织特性评价 支架内膜覆盖 OCT新生内膜的测量 支架置入后正性重构IVUS优于OCT OCT与IVUS的比较 支架内皮覆盖及微通道 新生内膜厚度与面积的评价 A B C Barlis et al. EuroInterv J 2008 内膜异质性 Gonzalo et al. Am Heart J 2009 OCT 对支架新生内膜的定性和定量分析 BMS内脂质斑块 支架内不稳定斑块的破裂 支架内不稳定斑块的破裂可能是晚期支架内血栓的成因之一 IVUS 在左主干病变中应用的优势 IVUS指导下LM DES 植入后全因死亡率的影响 (n=805) (SJ Park et al. TCT 2007) 支架植入后时间 Cumulative Incidence ( %) 1.5 1.0 0.0 0.5 2.5 3.0 70 100 80 2.0 IVUS (n=595) No IVUS (n=210) 90 95.2% 85.6% IVUS was an independent predictor of survival (HR=0.43, p=0.019) 罪犯病变,如夹层 支架内新生内膜 贴壁不良 OCT的优势-More detail information What can OCT and IVUS find？ OCT 斑块分类 FCT 夹层 内膜撕裂 贴壁不良 支架内新生内膜厚度 新生内膜组织特性 内膜异质性 IVUS EEM IEM 斑块负荷 重构指数 MLD MSA OCT-介入诊断的信息时代  谢 谢！ 知识回顾Knowledge Review * * * infiltrate * * In the IVUS Core Laboratory, for each coronary cross-section, technicians measured the external elastic membrane and the lumen areas, then calculated the atheroma area, shown here in gold. * 40mg瑞舒伐他汀治疗2年后斑块面积从10.16 mm2 降到 5.81 mm2 然而管腔面积没有明显改变 * * 81个尸检，62段病变血管段 * This slide shows the information that can be gathered from IVUS (20Mhz) and from OCT imaging. These are corresponding cross sections within a stent, imaged by both, IVUS in the upper panels and by OCT in the lower panels. The images represent the same spots within a coronary artery (A, B, C) , and illustrate the different quality of information that can be obtained by OCT as compared to conventional grey scale IVUS. In example A, 3 layers of stents can be seen. OCT is able to clearly visualize the individual stent struts, the neotinimal layers separating the different stents and the very thin coverage of the most inner, luminal stent struts. In example B, a bright, eccentric and relatively thick neointimal layer can be seen In example C, again an eccentric neotinimal layer is visible, but please note the completely different , low-reflective and speckled apperance of the neointma. Thus, OCT does not only allow to visualize very thin s