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صفحه اصلي > مقالات > مقالات خارجی > Intravascular Imaging 
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P U BLIS HE B  E L S EVIE I N C .                                                                                                                                                                       h ttp ://d x.doi.o r g/10.1 0 1 6/j.jacc.2014.01.015

 

REV I EW  T O PIC  O F  T HE  WEEK

 

 

Clinical Utility of Intravascular Imaging and Physiology  in Coronary Artery Disease

 

Gary  S. Mintz, MD

 

 

 

ABSTRACT

 

 

 

Intravascular imaging  and  physiology techniques and  technologies are moving  beyond the  framework of research to inform  clinical decision  making.  Currently  available  technologies and  techniques include  fractional flow reserve; grayscale intravascular ultrasound (IVUS); IVUS radiofrequency tissue  characterization; optical  coherence tomography, the  light analogue of IVUS; and near-infrared spectroscopy that detects lipid within the  vessel  wall and that has recently been  combined with grayscale IVUS in a single catheter as the  first combined imaging  device.  These tools  can be used  to answer questions that occur during daily practice, including:  Is this stenosis significant? Where is the culprit lesion? Is this a vulnerable plaque? What is the  likelihood  of distal  embolization or periprocedural myocardial infarction during  stent implantation? How do I optimize acute  stent results? Why did thrombosis or restenosis occur  in this  stent? One of the legacies of coronary angiography is to presume that one technique will answer  all of these questions; however, that often has been  proved inaccurate in contemporary practice.  (J Am Coll Cardiol 2014;64:207–22) © 2014  by the  American College  of Cardiology  Foundation

More  than 2 decades have passed since Drs. Nic Pijls   and  BernarDeBruyne intro- duced  fractional ow reserve (FFR as  a method of assessing coronary stenosiseverity and since Dr.  Paul Yock  invented grayscale intravascular ultrasoun(IVUS)  that  spawned second-generation intravasculaimaging techniques  such  as 1)  IVUS radiofrequency tissue characterization, including vir- tua histology   (VH)-IVUS,     integrate backscatter IVUS,   and  iMap; 2)  optical  coherence  tomography (OCT) the  light  analogue  o IVUS and  3)   near- infrared spectroscopy that  detects  lipid withithe vessewall and  that  has  recently  been  combined with grayscale IVUin a  single catheter as  the first combineimaging device. These tools havmoved beyond the research setting. They are  useful for answering questions that occur during daily practice including:  I thi stenosi signicant?  Where  is th culprit  lesion?  I this   vulnerable  plaque? What i the  likelihood o distal  embolization  or periproceduramyocardial   infarctio (MI)    during stent  implantation? How do   I  optimize acute stent results? Why dithrombosis  or  restenosis  occur in this stent?

The  subspecialty  o interventional   cardiology is dat driven Although  correlation with   histopa- thology ar important, the ultimate benefit will   be determined if these techniques improve clinical diagnosis, treatment,  outcomesand  whether  pa- tients benefit, irrespective of  technical or  histopath- ological accuracy.

 

IS  T H IS  ST ENO S IS  SIG N I F I C AN T?

 

Three randomized trials (DEFER  [Deferral Versus Performance  o PTCA   in  Patients  Without  Docu- mented Ischemia], FAM [Fractional  FloReserve Versus  Angiography  fo MultivesseEvaluation]-I, and  FAME-II established  FF (the ratio  o distal to proximal pressure at maximum hyperemia) as  the...

 

___________________________________________________________________________________

From the Cardiovascular Research Foundation, New  York,  New  York.  Dr. Mintz has  received speakers bureau and fellowship support from Boston Scientific; and is a consultant to and receives research support from Volcano Corporation and InfraReDx, Inc.

Manuscript received September 30,  2013; revised manuscript received January 2, 2014,  accepted January 14, 2014.


 

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