Optische Kohärenztomografie und intravaskulärer Ultraschall

Mit der Koronarangiografie erfasst man das Ausmaß und den Schweregrad einer KHK, stellt in Kombination mit hämodynamischen Messungen die Indikation zur Intervention und beurteilt deren Ergebnis. Um jedoch eine adäquate Strategie festzulegen oder das Ergebnis der Stentimplantation akut zu beurteilen, werden in der interventionellen Kardiologie zunehmend der intravaskuläre Ultraschall (IVUS) und die optische Kohärenztomografie (OCT) bei perkutanen Koronarinterventionen (PCI) eingesetzt.

Kernaussagen

• Die intrakoronare Bildgebung ermöglicht eine sehr detaillierte Bewertung der koronaren Stentimplantation und möglicher prozeduraler Komplikationen.

• Stentoptimierung bedeutet die Erfassung der Stentexpansion und -apposition.

• Die intravaskuläre Bildgebung kann prozedurale Komplikationen nach Stentimplantation nachweisen: Stentranddissektionen, Gewebs- oder Thrombusprotrusionen, Stentfraktur, Plaqueshift oder Koronarspasmus.

• OCT und IVUS unterscheiden sich technisch und im idealen Anwendungsspektrum. Da beide Verfahren unterschiedliche Stärken und Schwächen haben und gute randomisierte Daten über das tatsächliche Outcome der Patienten derzeit noch fehlen, kann eine komplementäre Anwendung beider Methoden in der klinischen Praxis durchaus sinnvoll sein.

• Interventionelle Kardiologen sollten mit mindestens einer der beiden intrakoronaren Bildgebungsverfahren IVUS oder OCT vertraut sein und eines der beiden vermehrt vor allem im Rahmen komplexer Koronarinterventionen einsetzen.

Schlüsselwörter

optische Kohärenztomografie - intravaskulärer Ultraschall - Koronarintervention - intrakoronare Bildgebung

Publikationsverlauf

Artikel online veröffentlicht:
10. September 2020

• Literatur

• 1 Maehara A, Matsumara M, Ali ZA. et al. IVUS-guided versus OCT-guided coronary stent implantation. JACC Cardiovasc Imaging 2017; 10: 1487-1503
• 2 Burke AP, Farb A, Malcolm GT. et al. Coronary risk factors and plaque morphology in men with coronary disease who died suddenly. N Engl J Med 1997; 336: 1276-1282
• 3 Garcia-Garcia HM, Gogas BD, Serruys PW. et al. IVUS-based imaging modalities for tissue characterization: similarities and differences. Int J Cardiovasc Imaging 2011; 27: 215-224
• 4 Stone GW, Maehara A, Lansky AJ. et al. A prospective natural-history study of coronary atherosclerosis. N Engl J Med 2011; 364: 226-235
• 5 Cheng JM, Garcia-Garcia HM, de Boer SP. et al. In vivo detection of high-risk coronary plaques by radiofrequency intravascular ultrasound and cardiovascular outcome: results of the ATHEROREMO-IVUS study. Eur Heart J 2014; 35: 639-647
• 6 Nair A, Kuban BD, Tuzcu EM. et al. Coronary plaque classification with intravascular ultrasound radiofrequency data analysis. Circulation 2002; 106: 2200-2206
• 7 Tearney GJ, Regar E, Akasaka T. et al. Consensus standards for acquisition, measurement, and reporting of intravascular optical coherence tomography studies: a report from the International Working Group for Intravascular Optical Coherence Tomography Standardization and Validation. J Am Coll Cardiol 2012; 59: 1058-1072
• 8 Prati F, Regar E, Mintz GS. et al. Expert review document on methodology, terminology, and clinical applications of optical coherence tomography: physical principles, methodology of image acquisition, and clinical application for assessment of coronary arteries and atherosclerosis. Eur Heart J 2010; 31: 401-415
• 9 Jang IK, Tearney GJ, MacNeill B. et al. In vivo characterization of coronary atherosclerotic plaque by use of optical coherence tomography. Circulation 2005; 111: 1551-1555
• 10 Räber L, Mintz GS, Koskinas KC. et al. Clinical use of intracoronary imaging: guidance and optimization of coronary interventions. An expert consensus document of the European association of percutaneous cardiovascular interventions. EuroIntervention 2018; 14: 656-677
• 11 Ali ZA, Nef H, Escaned J. et al. Safety and effectiveness of coronary intravascular lithotripsy for treatment of severly calcified coronary stenoses: The Disrupt CAD II study. Circ Cardiovasc Interv 2019; 12: e008434 doi:10.1161/CIRCINTERVENTIONS.119.008434
• 12 Schiele F, Meneveau N, Vuillemenot A. et al. Impact of intravascular ultrasound guidance in stent deployment on 6-month restenosis rate: a multicenter, randomized study comparing two strategies – with and without intravascular ultrasound guidance. RESIST Study Group. REStenosis after Ivus guided STenting. J Am Coll Cardiol 1998; 32: 320-328
• 13 Fitzgerald PJ. et al. Final results of the Can Routine Ultrasound Influence Stent Expansion (CRUISE) study. Circulation 2000; 102: p.523-530
• 14 Adriaenssens T, Joner M, Godschalk T. et al. Prevention of Late Stent Thrombosis by an Interdisciplinary Global European Effort (PRESTIGE) Investigators. Optical coherence tomography findings in patients with coronary stent thrombosis: a report of the PREvention of Late Stent Thrombosis by an Interdisciplinary Global European Effort (PRESTIGE) Consortium. Circulation 2017; 136: 1007-1021
• 15 Souteyrand G, Amabile N, Mangin L. et al. Mechanisms of stentthrombosis analysed by optical coherence tomography: insights from the national PESTO French registry. Eur Heart J 2016; 37: 1208-1216
• 16 Taniwaki M, Radu MD, Zaugg S. et al. Mechanisms of very late drug-eluting stent thrombosis assessed by optical coherence tomography. Circulation 2016; 133: 650-660
• 17 Neumann FJ, Sousa-Uva M, Ahlsson A. et al. 2018 ESC/EACTS guidelines on myocardial revascularization. Eur Heart J 2019; 40: 87-165
• 18 de Jaegere P, Mudra H, Figulla H. et al. Intravascular ultrasound-guided optimied stent deployment. Immediate an 6-months clinical and angiographic results from the Multicenter ultrasound stenting in Coronaries study (MUSIC Study). Eur Heart J 1998; 19: 1214-1223
• 19 Kubo T, Shinke T, Okamura T. et al. Optical frequency domain imaging vs. intravascular ultrasound in percutaneous coronary intervention (OPINION trial): one-year angiographic and clinical results. Eur Heart J 2017; 38: 3139-3147
• 20 Ali ZA, Maehara A, Généreux P. et al. Optical coherence tomography compared with intravascular ultrasound and with angiography to guide coronary stent implantation (ILUMIEN III: OPTIMIZE PCI): a randomised controlled trial. Lancet 2016; 388: 2618-2628
• 21 Kubo T, Akasaka T, Shite J. et al. OCT compared with IVUS in a coronary lesion assessment: the OPUS-CLASS study. JACC Cardiovasc Imaging 2013; 6: 1095-1104
• 22 Okamura T, Onuma Y, Garcia-Garcia H. et al. First-in-man evaluation of intravascular optical frequency domain imaging (OFDI) of Terumo: a comparison with intravascular ultrasound and quantitative coronary angiography. EuroIntervention 2011; 6: 1037-1045
• 23 Ahn J-M, Kang S-J, Yoon S-H. et al. Metaanalysis of outcomes after intravascular ultrasound-guided versus angiography-guided drug-eluting stent implantation in 26,503 patients enrolled in three randomized trials and 14 observational studies. Am J Cardiol 2014; 113: 1338-1347
• 24 Bezerra HG, Attizzani GF, Sirbu V. et al. Optical coherence tomography versus intravascular ultrasound to evaluate coronary artery disease and percutaneous coronary intervention. JACC Cardiovasc Interv 2013; 6: 228-236
• 25 Meneveau N, Souteyrand G, Motreff P. et al. Optical coherence tomography to optimize results of percutaneous coronary intervention in patients with non-ST-elevation acute coronary syndrome: results of the multicenter, randomized DOCTORS Study (Does Optical Coherence Tomography Optimize Results of Stenting). Circulation 2016; 134: 906-917
• 26 Guagliumi G, Sirbu V, Musumeci G. et al. Examination of the in vivo mechanisms of late drug-eluting stent thrombosis: findings from optical coherence tomography and intravascular ultrasound imaging. JACC Cardiovasc Interv 2012; 5: 12-20
• 27 Kume T, Okura H, Miyamoto Y. et al. Natural history of stent edge dissection, tissue protrusion and incomplete stent apposition detectable only on optical coherence tomography after stent implantation – preliminary observation. Circ J 2012; 76: 698-703
• 28 Prati F, Di Vito L, Biondi-Zoccai G. et al. Angiography alone versus angiography plus optical coherence tomography to guide decision-making during percutaneous coronary intervention: the Centro per la Lotta contro lʼInfarto-Optimisation of Percutaneous Coronary Intervention (CLI-OPCI) study. EuroIntervention 2012; 8: 823-829
• 29 Hong SJ, Mintz GS, Ahn CM. et al. Effect of intravascular ultrasound-guided drug-eluting stent implantation: 5-year follow-up of the IVUS-XPL randomized trial. JACC Cardiovasc Interv 2020; 13: 62-71
• 30 Witzenbichler B, Maehara A, Weisz G. et al. Relationship between intravascular ultrasound guidance an clinical outcomes after drug-eluting stents: the assessment of dual antiplatelet therapy with drug-eluting stents (ADAPT-DES) study. Circulation 2014; 129: 463-470
• 31 Buccheri S, Franchina G, Romano S. et al. Clinical outcomes following intravascular imaging-guided versus coronary angiography-guided percutaneous coronary intervention with stent implantation: a systematic review and Bayesian network meta-analysis of 31 studies and 17 882 patients. JACC Cardiovasc Interv 2017; 10: 2488-2498