Aktuelle Kardiologie 2013; 2(4): 241-247
DOI: 10.1055/s-0032-1325073
Übersichtsarbeit
Georg Thieme Verlag KG Stuttgart · New York

Intrakoronare Funktions- und Bildgebungsdiagnostik

Intracoronary Functional Diagnosis and Imaging
Anastasios Athanasiadis
1   Robert-Bosch-Krankenhaus, Zentrum für Innere Medizin, Kardiologie, Stuttgart
,
Harald Mudra
2   Städtisches Klinikum München, Klinikum Neuperlach, Klinik für Kardiologie, Pneumologie und Intensivmedizin, München
,
Udo Sechtem
1   Robert-Bosch-Krankenhaus, Zentrum für Innere Medizin, Kardiologie, Stuttgart
› Institutsangaben
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Publikationsverlauf

Publikationsdatum:
19. August 2013 (online)

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.

 
  • Literatur

  • 1 Pijls NHJ, Sels JW. Functional measurement of coronary stenosis. J Am Coll Cardiol 2012; 59: 1045-1057
  • 2 Wijns W, Kolh P, Danchin N et al. Guidelines on myocardial revascularization. Eur Heart J 2010; 31: 2501-2555
  • 3 Pijls NH, Fearon WF, Tonino PA et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention in patients with multivessel coronary artery disease: 2-year follow-up of the FAME (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation) study. J Am Coll Cardiol 2010; 56: 177-184
  • 4 De Bruyne B, Pijls NH, Kalesan B et al. Fractional flow reserve-guided PCI versus medical therapy in stable coronary disease. N Engl J Med 2012; 367: 991-1001
  • 5 Pijls NH, van Schaardenburgh P, Manoharan G et al. Percutaneous coronary intervention of functionally nonsignificant stenosis: 5-year follow-up of the DEFER Study. J Am Coll Cardiol 2007; 49: 2105-2111
  • 6 Miller DD, Donohue TJ, Younis LT et al. Correlation of pharmacological 99 mTc-sestamibi myocardial perfusion imaging with poststenotic coronary flow reserve in patients with angiographically intermediate coronary artery stenoses. Circulation 1994; 89: 2150-2160
  • 7 McDaniel MC, Eshtehardi P, Sawaya FJ et al. Contemporary clinical applications of coronary intravascular ultrasound. JACC Cardiovasc Interv 2011; 4: 1155-1167
  • 8 Waksman R, Legutko J, Singh J et al. FIRST: Fractional Flow Reserve and Intravascular Ultrasound Relationship Study. J Am Coll Cardiol 2013; 61: 917-923
  • 9 Leesar MA, Masden R, Jasti V. Physiological and intravascular ultrasound assessment of an ambiguous left main coronary artery stenosis. Catheter Cardiovasc Interv 2004; 62: 349-357
  • 10 Jasti V, Ivan E, Yalamanchili V et al. Correlations between fractional flow reserve and intravascular ultrasound in patients with an ambiguous left main coronary artery stenosis. Circulation 2004; 110: 2831-2836
  • 11 Fihn SD, Gardin JM, Abrams J et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease. J Am Coll Cardiol 2012; 60: e44-e164
  • 12 Park SJ, Kim YH, Park DW et al. Impact of intravascular ultrasound guidance on long-term mortality in stenting for unprotected left main coronary artery stenosis. Circ Cardiovasc Interv 2009; 2: 167-177
  • 13 de Jaegere P, Mudra H, Figulla H et al. Intravascular ultrasound-guided optimized stent deployment. Immediate and 6 months clinical and angiographic results from the Multicenter Ultrasound Stenting in Coronaries Study (MUSIC Study). Eur Heart J 1998; 19: 1214-1223
  • 14 Chieffo A, Latib A, Caussin C et al. A prospective, randomized trial of intravascular-ultrasound guided compared to angiography guided stent implantation in complex coronary lesions: the AVIO trial. Am Heart J 2013; 165: 65-72
  • 15 Levine GN, Bates ER, Blankenship JC et al. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. J Am Coll Cardiol 2011; 58: e44-e122
  • 16 Stone GW, Maehara A, Lansky AJ et al. A prospective natural-history study of coronary atherosclerosis. N Engl J Med 2011; 364: 226-235
  • 17 Bezerra HG, Costa MA, Guagliumi G et al. Intracoronary optical coherence tomography: a comprehensive review. J Am Coll Cardiol Intv 2009; 2: 1035-1046
  • 18 Regar E, Ligthart J, Bruining N et al. The diagnostic value of intracoronary optical coherence tomography. Herz 2011; 36: 417-429
  • 19 Barlis P, Regar E, Serruys PW et al. An optical coherence tomography study of a biodegradable vs. durable polymer-coated limus-eluting stent: a LEADERS trial sub-study. Eur Heart J 2010; 31: 165-176
  • 20 Serruys PW, Onuma Y, Dudek D et al. Evaluation of the second generation of a bioresorbable everolimus-eluting vascular scaffold for the treatment of de novo coronary artery stenosis: 12-month clinical and imaging outcomes. J Am Coll Cardiol 2011; 58: 1578-1588