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DOI: 10.1055/s-0032-1325073
Intrakoronare Funktions- und Bildgebungsdiagnostik
Intracoronary Functional Diagnosis and ImagingPublication History
Publication Date:
19 August 2013 (online)
![](https://www.thieme-connect.de/media/aktkardio/201304/lookinside/thumbnails/10.1055-s-0032-1325073-1.jpg)
Zusammenfassung
Die Limitationen der konventionellen Koronarangiografie führten in den letzten Jahren zur Weiterentwicklung intrakoronarer Bildgebungstechniken. Der intravaskuläre Ultraschall ermöglicht nicht nur Einblicke in die Koronaranatomie und -morphologie, sondern findet auch Einsatz in der Optimierung und Steuerung einer perkutanen Intervention. Durch eine neue, auf Infrarotlicht basierte Technik, der optischen Kohärenztomografie, können intra- und extraluminale Gefäßstrukturen in einer höheren Auflösung dargestellt werden. Doch selbst die modernsten diagnostischen Verfahren sind in der Beurteilung der Funktionalität einer Stenose limitiert. Die fraktionelle Flussreserve erlaubt mit einer hohen Sensitivität und Spezifität den Nachweis einer hämodynamischen Signifikanz einer Stenose und bietet Vorteile in der Steuerung einer Intervention. Die Bestimmung der koronaren Flussreserve führt ein eher stiefmütterliches Dasein, da diese lediglich zum Nachweis einer mikrovaskulären Funktionsstörung eingesetzt werden kann.
Abstract
The limitations of conventional coronary angiography have facilitated the development of new intracoronary imaging techniques in the last years. The intravascular ultrasound does not only enable insights into the coronary morphology and plaque composition but can also guide and optimize percutaneous coronary interventions. Optical coherence tomography, a new modality based on infrared light, provides imgaging of intraluminal and extraluminal structures in a higher resolution which is better than intravascular ultrasound. However, even these new technologies are not able to assess the relevance of a coronary stenosis. Thus, newer tools were developed, such as the fractional and coronary flow reserve. The evaluation of the fractional flow reserve can identify hemodynamic significant stenoses with a high specificity and sensitivity. Furthermore guidance of interventions using fractional flow reserve provides more benefits than angiographically driven decisions. Coronary flow reserve may distinguish a microvascular dysfunction.
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