光学相干断层成像用于冠状动脉支架术后评价

光学相干断层成像（OCT）是以光为基础的成像模式,早期主要应用于眼科领域,现在OCT在冠状动脉中的应用显示其拥有巨大的潜力[1]。与血管内超声（IVUS）比较,OCT提供了10倍于IVUS的分辨率。这种高分辨率的优势对评价动脉粥样斑块特征（包括测量纤维帽厚度、罪犯斑块内巨噬细胞密度）及支架附壁和组织覆盖的情况,是目前其他成像模式无法比拟的。冠状动脉内OCT成像的临床应用,为了解冠状动脉内细微结构改变开辟了一个新时代。     

光学相干断层扫描评价糖尿病冠心病患者冠脉病变的进展

糖尿病可促进血管内膜增生,易损斑块破裂,血栓形成,支架边缘夹层等。光学相干断层扫描（OCT）是目前最先进的血管内成像技术,临床主要用于识别冠状动脉易损斑块和药物洗脱支架（DES）置入术后随访。该文主要介绍OCT评估糖尿病冠心病患者冠状动脉病变特点。     

光学相干断层成像系统在经皮冠状动脉介入术后评估中的应用

光学相干断层成像系统（optical coherence tomography,OCT）是一种高分辨率的医学断层成像技术,可以提供冠状动脉的微观成像。OCT定义的薄纤维帽斑块是指纤维帽厚度不足65um的脂质斑块,常用作评估经皮冠状动脉介入治疗（percutaneous coronary intervention,PCI）术后并发症,     

光学相干断层成像评价经皮冠状动脉内支架术后即刻效果

冠状动脉内光学相干断层成像（OCT）是近几年发展起来的一种具有高分辨率和对比度的冠状动脉断层成像技术，其分辨率达10，比目前所有已知的冠状动脉成像检查方法高10倍以上，可以显示冠状动脉病变以及介入治疗后支架周围超微结构的改变。我中心自2005年8月开展OCT检查技术，初步研究结果显示该项检查安全有效，能够分辨斑块的细节特征，识别易损斑块，为介入治疗提供决策依据。本研究的目的是利用OCT分析冠状动脉支架置入术后支架周围超微结构特征。     

光学相干断层成像技术在检测动脉粥样硬化病变中的应用

光学相干断层成像（optical coherence tomography,OCT）是一种新的高分辨率断面成像模式,它将新发展的光学技术与超灵敏探测合为一体,加上现代计算机图像处理,发展成为一门新兴的断层成像诊断技术。易损斑块是指所有易于发生血栓的斑块和十分可能迅速进展成为罪犯斑块的种种斑块。但现有的筛查和诊断的方法不足以在急性心血管病事件发生之前将易损斑块识别出来。此外,动脉粥样斑块从稳定变为易损的过程涉及炎症、免疫、代谢、凝血等多个环节,单纯显示动脉管腔或斑块形态的诊断技术已不能满足临床的需要。因此,OCT技术在识别动脉粥样斑块成分、鉴别易损斑块和指导介入治疗过程等方面的作用备受关注并得到广泛的研究。     

光学相干断层成像技术对冠状动脉斑块应用的进展

冠状动脉内光学相干断层成像技术(OCT)的应用可以提供精确的斑块形态学特征,识别易损病变,优化支架植入并指导血运重建策略。其对于易损斑块的识别为个性化风险的评估铺平道路,并为改善临床预后提供可能。本文就OCT对冠脉斑块的应用作一综述。     

光学相干断层成像技术在冠状动脉介入诊疗中的应用

随着经皮冠状动脉介入（PCI）技术的不断发展，血管内成像技术在冠状动脉疾病临床诊疗中正发挥日益重要的作用。光学相干断层成像技术（OCT）作为新一代血管内成像技术，它可以提供更高分辨率的图像以及接近显微水平的斑块特性，支架内再狭窄，血栓特征等细节，而这又决定它可以更好地预测急性冠脉综合症的发生以及更准确的识别其病因。目前，有研究表明OCT对PCI手术的优化及对支架内皮化、新生内膜增生的评价可以改善及预判临床预后，相信随着OCT技术的进一步发展，它在冠状动脉疾病临床诊疗中的应用的广度及深度将会显著增加，将发挥越来越重要的作用。     

光学相干断层成像对急性冠状动脉综合征患者易损斑块的新认识

血管斑块的稳定性是影响急性冠状动脉综合征发生发展的主要因素,具有超高空间分辨率的光学相干断层成像(OCT)技术在易损斑块识别方面有着独特的优势。本文就近年来OCT在急性冠状动脉综合征患者易损斑块识别方面的临床新进展进行综述。     

OCT-IVUS一体成像的多模态血管腔内成像技术的应用与进展

作为冠状动脉介入诊疗中最主要的两种血管腔内影像学技术,光学相干断层成像(OCT)和血管内超声(IVUS)已在临床应用数十年。OCT具有更高的分辨率,能更好地对比斑块成分,IVUS能够穿透血液,具有更深的成像深度,两种影像学技术已成为心血管介入医生不可或缺的辅助手段。但两种影像学技术也各有不足,OCT成像穿透深度有限,IVUS的空间分辨率较弱。单一的OCT或IVUS很难完全提供血管及斑块内部完整的解剖学信息。利用二者的互补性,将OCT与IVUS成像导管集成到同一成像导管中,实现二者的多模态血管内成像,则可以为介入医生提供更加理想的斑块与血管壁的组织学和形态学信息。     

光学相干断层成像评价易损斑块的应用进展

急性心血管事件是致死率极高的疾病,粥样斑块破裂后血栓形成被认为是许多急性心血管事件的直接原因。在过去几十年里,光学相干断层成像(OCT)逐渐被运用于准确识别易损斑块,OCT是一种利用光学原理的血管内成像新技术,具有高分辨率及良好的组织相关性。现就将OCT评价易损斑块的应用进展做一综述。     

用光学相干断层扫描比较两种类型冠心病受累血管病变的特点

目的：用光学相干断层扫描（OCT）比较急性心肌梗死（AMI）及稳定型心绞痛（SAP）受累血管病变的特征。方法：选取140例接受冠脉造影（CAG）及OCT检查的患者,其中61例AMI患者,79例SAP患者。分析患者的临床相关信息,用OCT评价受累血管的病变特点。结果：纤维帽厚度在AMI组比SAP组薄［（45±13） μm vs.（80±39） μm,P〈0.01）］;薄纤维帽富含脂质的斑块更多见于AMI组（56% vs. 25%,P〈0.01）;血栓更多见于AMI组（52% vs. 5%,P〈0.01）;斑块破裂的发生率分别是（67% vs. 25%）,P〈0.01）,溃疡和夹层等较重的斑块破裂均发生AMI组;4个象限的富含脂质斑块更易出现在AMI组;钙化斑块的深度及广度在2组间没有明显区别,但≥2象限的钙化斑块有多见SAP组趋势。结论：OCT能准确评价冠状动脉受累血管病变的病变特点及结构特征。AMI患者脂质斑块纤维帽更薄,更多见斑块破裂、血栓及不稳定脂质斑块。     

光学相干断层扫描在冠脉介入治疗方面的发展现状

光学相干断层扫描是迄今为止被认为最有效的辨认易损斑块形态及评估支架术后内膜覆盖程度的工具。光学相干断层扫描可用于指导支架植入，评价支架内膜增生情况，探讨支架内再狭窄的原因，检出支架晚期贴壁不良和支架内血栓形成等方面。     

血管内光学干涉断层成像在老年冠脉临界病变诊疗中的应用

尽管多种无创性冠脉影像诊断方法以及冠脉造影已经成为现代冠心病诊疗的重要手段,但是在决定冠脉临界病变程度、是否需要进行介入治疗、以及早期识别易损斑块和准确评价支架植入即刻和远期效果等方面仍然存在很多困难与争议。血管内光学干涉断层成像在管腔狭窄程度、范围以及斑块性质的显示方面有不可比拟的优势,其组织分辨率大约较IVUS高10倍,近似病理组织学程度,但是其在老年冠心病人中的应用极少。本文综述冠脉临界病变的影像诊断进展,以有助于危险评估、治疗决策,最终促进介入治疗的合理应用。     

Visualization of coronary atherosclerotic plaques in patients using optical coherence tomography: comparison with intravascular ultrasound

OBJECTIVES: The aim of this study was to evaluate the feasibility and the ability of intravascular optical coherence tomography (OCT) to visualize the components of coronary plaques in living patients. BACKGROUND: Disruption of a vulnerable coronary plaque with subsequent thrombosis is currently recognized as the primary mechanism for acute myocardial infarction. Although such plaques are considered to have a thin fibrous cap overlying a lipid pool, imaging modalities in current clinical practice do not have sufficient resolution to identify thin (< 65 microm) fibrous caps. Optical coherence tomography is a new imaging modality capable of obtaining cross-sectional images of coronary vessels at a resolution of approximately 10 microm. METHODS: The OCT images and corresponding histology of 42 coronary plaques were compared to establish OCT criteria for different types of plaques. Atherosclerotic lesions with mild to moderate stenosis were identified on angiograms in 10 patients undergoing cardiac catheterization. Optical coherence tomography and intravascular ultrasound (IVUS) images of these sites were obtained in all patients without complication. RESULTS: Comparison between OCT and histology demonstrated that lipid-rich plaques and fibrous plaques have distinct OCT characteristics. A total of 17 IVUS and OCT image pairs obtained from patients were compared. Axial resolution measured 13 +/- 3 microm with OCT and 98 +/- 19 microm with IVUS. All fibrous plaques, macrocalcifications and echolucent regions identified by IVUS were visualized in corresponding OCT images. Intimal hyperplasia and echolucent regions, which may correspond to lipid pools, were identified more frequently by OCT than by IVUS. CONCLUSIONS: Intracoronary OCT appears to be feasible and safe. Optical coherence tomography identified most architectural features detected by IVUS and may provide additional detailed structural information.     

白三烯B4和MMP-9与颈动脉斑块稳定性的相关性探讨

目的探讨血浆白三烯-B4(LT-B4)、MMP-9的水平与颈动脉不稳定斑块的关系。方法根据超声将352例颈动脉斑块的患者,稳定斑块组(127例)和不稳定斑块组(225例),无颈动脉斑块患者125例为对照组。应用ELISA法测定患者外周血浆LT-B4、基质金属蛋白酶-9(MMP-9)。结果颈动脉斑块组患者血清LT-B4、MMP-9水平均高于对照组,差异有统计学意义(P<0.05);不稳定斑块组患者血清LT-B4、MMP-9浓度水平均高于稳定斑块组,差异有统计学意义(P<0.01);LT-B4水平升高是颈动脉不稳定斑块的危险因素(OR=2.104,95%CI:1.526~3.015)。结论血清白三烯B4、MMP-9与不稳定的颈动脉斑块有关。     

冠状动脉光学相干断层成像与血管内超声成像临床应用进展

光学相干断层成像技术和血管内超声成像技术是现行两种主要的冠状动脉血管内成像技术。光学相干断层成像技术具有分辨率高,组织相关性良好等特点;血管内超声成像技术具有穿透性高,成像范围广等特点。在临床应用中,两种技术有着各自的优势,两者的结合应用可以提供更多的一临床信息。现就不同临床应用中光学相干断层成像技术与血管内超声成像技术的评价能力进行对比,并对光学相干断层成像技术与血管内超声成像技术的结合应用进行简要介绍。     

Assessing atherosclerotic plaque morphology: comparison of optical coherence tomography and high frequency intravascular ultrasound.

BACKGROUND: OCT can image plaque microstructure at a level of resolution not previously demonstrated with other imaging techniques because it uses infrared light rather than acoustic waves. OBJECTIVES: To compare optical coherence tomography (OCT) and intravascular ultrasound (IVUS) imaging of in vitro atherosclerotic plaques. METHODS: Segments of abdominal aorta were obtained immediately before postmortem examination. Images of 20 sites from five patients were acquired with OCT (operating at an optical wavelength of 1300 nm which was delivered to the sample through an optical fibre) and a 30 MHz ultrasonic transducer. After imaging, the microstructure of the tissue was assessed by routine histological processing. RESULTS: OCT yielded superior structural information in all plaques examined. The mean (SEM) axial resolution of OCT and IVUS imaging was 16 (1) and 110 (7), respectively, as determined by the point spread function from a mirror. Furthermore, the dynamic range of OCT was 109 dB compared with 43 dB for IVUS imaging. CONCLUSIONS: OCT represents a promising new technology for intracoronary imaging because of its high resolution, broad dynamic range, and ability to be delivered through intravascular catheters.     

Optical Coherence Tomography (OCT)

BACKGROUND: It is believed that most myocardial infarctions result from the rupture of "vulnerable plaques", that share certain common characteristics. These plaques typically consist of a lipid-rich core in the central portion of the thickened intima, covered by a thin friable fibrous cap. Today, one of the important challenges in the field of interventional cardiology is how to identify minor or silent plaques that carry the risk of thrombosis resulting in severe cardiac events. Current imaging technologies lack the resolution to reliably identify these lesions. OCT: Optical Coherence Tomography (OCT) might have the potential to fill this role. OCT is a new non-contact, light-based imaging modality providing in situ images of tissues at near histologic resolution. As shown in various preclinical and clinical reports, OCT allows the identification of mural as well as luminal morphologies including lumen dimensions, plaques, thrombi, dissections, tissue flaps as well as information on stent geometries including apposition and symmetry. Trials comparing intravascular ultrasound (IVUS) and OCT demonstrated that OCT provided additional morphologic information, which could be used to improve plaque characterization. CONCLUSION: OCT has the potential to provide a new and more detailed look into the vessel wall, which might help to identify plaques that are at risk of rupture, and furthermore, which will influence and guide the appropriate patient-specific therapeutic approach.     

Assessment of coronary plaque with optical coherence tomography and high-frequency ultrasound

This study compares the ability of intravascular optical coherence tomography (OCT) and high-frequency intravascular ultrasound (IVUS) to image highly stenotic human coronary arteries in vitro. Current imaging modalities have insufficient resolution to perform risk stratification based on coronary plaque morphology. OCT is a new technology capable of imaging at a resolution of 5 to 20 microm, which has demonstrated the potential for coronary arterial imaging in prior experiments. Human postmortem coronary arteries with severely stenotic segments were imaged with catheter-based OCT and IVUS. The OCT system had an axial resolution of 20 microm and a transverse resolution of 30 microm. OCT was able to penetrate and image near-occlusive coronary plaques. Compared with IVUS, these OCT images demonstrated superior delineation of vessel layers and lack of ring-down artifact, leading to clearer visualization of the vessel plaque and intima. Histology confirmed the accuracy and high contrast of vessel layer boundaries seen on OCT images. Thus, catheter-based OCT systems are able to image near-occlusive coronary plaques with higher resolution than that of IVUS.     

阿托伐他汀对兔动脉粥样硬化斑块近心端基质金属蛋白酶9表达的影响

目的 研究阿托伐他汀对兔主动脉粥样硬化斑块近心端基质金属蛋白酶9（MMP-9）表达的影响。方法 将30只雄性新西兰大白兔随机分为正常对照组（9只）、高脂饮食组（11只）、阿托伐他汀组（10只）。后两组给予高胆固醇饲料建立主动脉粥样硬化模型，至第9周始，高脂饮食组同时服用1．5mg·kg^-1·d^-1淀粉，阿托伐他汀组服用阿托伐他汀1．5mg·kg^-1·d^-1。处死兔后，对主动脉大体标本进行观察，发现内膜增生合并粥样斑块形成者视为模型建立成功。应用免疫组化法测定斑块近心端的巨噬细胞和平滑肌细胞阳性面积百分率以及MMP-9的表达。结果 ①高脂饮食组和阿托伐他汀组主动脉可见新生内膜形成，内一中膜厚度比值分别为1．41±0．34、0．63±0．12。②斑块中巨噬细胞分布部位正是MMP-9阳性表达区域，均聚集于斑块近心端。高脂饮食组和阿托伐他汀组主动脉斑块近心端巨噬细胞阳性面积百分比分别为（26．5±4．3）％、（12．4±1．5）％，MMP-9吸光度（A值）分别为0．081±0．014、0．022±0．004，两组比较差异均有统计学意义（P〈0．01）。③高脂饮食组与阿托伐他汀组平滑肌细胞阳性面积百分比分别为（47．2±12．3）％、（50．4±10．8）％，差异无统计学意义（P〉0．05）。结论 动脉粥样硬化斑块内巨噬细胞及MMP-9表达主要位于主动脉粥样硬化斑块近心端，阿托伐他汀能显著减少此区域巨噬细胞聚集及MMP-9的表达。