Intrakoronare Bildgebung – wie die Plaque-Morphologie die Therapie personalisiert

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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 Ultraschall

Key words

intracoronary imaging - plaque morphology - optical coherence tomography - intravascular ultrasound

Publication History

Article published online:
26 November 2021

• Literatur

• 1 Shlofmitz E, Ali ZA, Maehara A. et al. Intravascular Imaging-Guided Percutaneous Coronary Intervention: A Universal Approach for Optimization of Stent Implantation. Circ Cardiovasc Interv 2020; 13: e008686 DOI: 10.1161/CIRCINTERVENTIONS.120.008686.
• 2 Zhang J, Gao X, Kan J. et al. Intravascular Ultrasound Versus Angiography-Guided Drug-Eluting Stent Implantation: The ULTIMATE Trial. J Am Coll Cardiol 2018; 72: 3126-3137 DOI: 10.1016/j.jacc.2018.09.013.
• 3 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 DOI: 10.1016/j.jacc.2011.09.079.
• 4 Leistner DM, Krankel N, Meteva D. et al. Differential immunological signature at the culprit site distinguishes acute coronary syndrome with intact from acute coronary syndrome with ruptured fibrous cap: results from the prospective translational OPTICO-ACS study. Eur Heart J 2020; 41: 3549-3560 DOI: 10.1093/eurheartj/ehaa703.
• 5 Johnson TW, Raber L, di Mario C. et al. Clinical use of intracoronary imaging. Part 2: acute coronary syndromes, ambiguous coronary angiography findings, and guiding interventional decision-making: an expert consensus document of the European Association of Percutaneous Cardiovascular Interventions. Eur Heart J 2019; 40: 2566-2584 DOI: 10.1093/eurheartj/ehz332.
• 6 Dai J, Xing L, Jia H. et al. In vivo predictors of plaque erosion in patients with ST-segment elevation myocardial infarction: a clinical, angiographical, and intravascular optical coherence tomography study. Eur Heart J 2018; 39: 2077-2085 DOI: 10.1093/eurheartj/ehy101.
• 7 Kim ESH. Spontaneous Coronary-Artery Dissection. N Engl J Med 2020; 383: 2358-2370 DOI: 10.1056/NEJMra2001524.
• 8 Xing L, Yamamoto E, Sugiyama T. et al. EROSION Study (Effective Anti-Thrombotic Therapy Without Stenting: Intravascular Optical Coherence Tomography-Based Management in Plaque Erosion): A 1-Year Follow-Up Report. Circ Cardiovasc Interv 2017; 10: e005860 DOI: 10.1161/CIRCINTERVENTIONS.117.005860.
• 9 Hong SJ, Kim BK, Shin DH. et al. Effect of Intravascular Ultrasound-Guided vs Angiography-Guided Everolimus-Eluting Stent Implantation: The IVUS-XPL Randomized Clinical Trial. JAMA 2015; 314: 2155-2163 DOI: 10.1001/jama.2015.15454.
• 10 Ali ZA, Brinton TJ, Hill JM. et al. Optical Coherence Tomography Characterization of Coronary Lithoplasty for Treatment of Calcified Lesions: First Description. JACC Cardiovasc Imaging 2017; 10: 897-906 DOI: 10.1016/j.jcmg.2017.05.012.
• 11 De Maria GL, Scarsini R, Banning AP. Management of Calcific Coronary Artery Lesions: Is it Time to Change Our Interventional Therapeutic Approach?. JACC Cardiovasc Interv 2019; 12: 1465-1478 DOI: 10.1016/j.jcin.2019.03.038.
• 12 Schneider VS, Bohm F, Blum K. et al. Impact of real-time angiographic co-registered optical coherence tomography on percutaneous coronary intervention: the OPTICO-integration II trial. Clin Res Cardiol 2021; 110: 249-257 DOI: 10.1007/s00392-020-01739-1.
• 13 Prati F, Romagnoli E, Gatto L. et al. Relationship between coronary plaque morphology of the left anterior descending artery and 12 months clinical outcome: the CLIMA study. Eur Heart J 2020; 41: 383-391 DOI: 10.1093/eurheartj/ehz520.
• 14 Nicholls SJ, Puri R, Anderson T. et al. Effect of Evolocumab on Progression of Coronary Disease in Statin-Treated Patients: The GLAGOV Randomized Clinical Trial. JAMA 2016; 316: 2373-2384 DOI: 10.1001/jama.2016.16951.
• 15 AMGEN. Press Releases: New Data At ESC Congress 2021 Shows Repatha® (evolocumab) Improves Features Of Plaque Stability In Patients With Acute Coronary Syndrome (ACS). 27.08.2021. https://www.amgen.com/newsroom/press-releases/2021/08/new-data-at-esc-congress-2021-shows-repatha-evolocumab-improves-features-of-plaque-stability-in-patients-with-acute-coronary-syndrome-acs . Stand: 17.10.2021
• 16 Stone GW, Maehara A, Ali ZA. et al. Percutaneous Coronary Intervention for Vulnerable Coronary Atherosclerotic Plaque. J Am Coll Cardiol 2020; 76: 2289-2301 DOI: 10.1016/j.jacc.2020.09.547.