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DOI: 10.1055/a-1361-8103
Intrakoronare Bildgebung – wie die Plaque-Morphologie die Therapie personalisiert
Intracoronary imaging – how plaque morphology impacts personal medical therapy![](https://www.thieme-connect.de/media/dmw/202123/lookinside/thumbnails/dmw-13618103_10-1055-a-1361-8103-1.jpg)
Was ist neu?
Management akutes Koronarsyndrom Im Rahmen der akuten Versorgung eines akuten Koronarsyndroms (ACS) gewinnt die intrakoronare Bildgebung (IKB) immer mehr an Bedeutung, da sie das weitere Prozedere maßgeblich beeinflussen kann. Sie erlaubt nicht nur die genauere Abgrenzung zwischen einem Typ-I- und Typ-II-Myokardinfarkt, sondern auch die Determinierung der das ACS auslösenden Pathophysiologie und – darauf aufbauend – auch des therapeutischen Prozederes. So kann die zweithäufigste ACS-Ursache, die Plaque-Erosion, mittlerweile nur pharmakologisch, ohne Koronarintervention, behandelt werden.
Verbesserung des perkutanen koronaren Interventionsergebnisses Mit dem Ziel einer optimalen Stentexpansion und -apposition ist der durch die IKB gewonnene Einblick in die Plaque-Morphologie von besonderem Vorteil. Hierbei erlaubt die IKB eine genauere Darstellung von das PCI-Ergebnis beeinflussenden Plaquecharakteristika, speziell der koronaren Kalzifizierung. Mithilfe der IKB kann nicht nur die optimale Methode der Läsionspräparation gewählt werden, sondern auch die Stenttherapie optimiert werden, um so periprozedurale Risiken zu reduzieren.
Risikostratifizierung bei koronarer Herzkrankheit Durch genauere In-vivo-Darstellung von Koronarplaques ermöglicht die IKB, Plaques zu identifizieren, welche ein besonders hohes Risiko haben, ein akutes Koronarsyndrom auszulösen, und erlaubt somit eine optimierte Risikostratifizierung und darauf ausgerichtete Therapien mit der Zielsetzung, die koronare Plaquestabilität zu verbessern.
Abstract
Even with emerging evidence that the use of intracoronary imaging techniques can significantly support the interventional procedure, the use of intracoronary imaging during catheterization procedures still remains comparatively low. With the help of intracoronary imaging percutaneous coronary interventions can be optimized and fundamental information about the plaque morphology can be archived. This is not only beneficial in determining plaque vulnerability but can also assist in the interventional approach of complex lesions including calcified lesions, as well as lesions causing an acute coronary syndrome. Especially in the context of the latter, identification of the underlying entity may provide alternative personalized approaches for patients with acute coronary syndrome.
Schlüsselwörter
intrakoronare Bildgebung - Plaque-Morphologie - optische Kohärenztomografie - intravaskulärer UltraschallKey words
intracoronary imaging - plaque morphology - optical coherence tomography - intravascular ultrasoundPublikationsverlauf
Artikel online veröffentlicht:
26. November 2021
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