Welche intrakoronare Diagnostik: funktionell oder morphologisch?

Zusammenfassung

Die funktionelle und morphologische intrakoronare Diagnostik stellt eine wesentliche Ergänzung der konventionellen Koronarangiografie dar und ist aus der modernen interventionellen Kardiologie nicht mehr wegzudenken. Mittels der Messung der fraktionellen Flussreserve (FFR) kann insbesondere bei mittelgradigen Koronarstenosen deren hämodynamische Relevanz einfach quantifiziert und so die Indikation zur Koronarintervention gestellt werden. Moderne morphologische Untersuchungstechniken wie der intravaskuläre Ultraschall (IVUS) oder die optische Kohärenztomografie (OCT) liefern ein tomografisches Bild der Koronargefäße hoher Auflösung (150–300 µm bzw. 15–40 µm). Hierdurch lassen sich wichtige Informationen zur Plaquekomposition wie auch zur Gefäßgeometrie gewinnen, welche die Interventionsstrategie wie auch die Auswahl der Ballons und Implantate wesentlich beeinflussen können. Jede dieser Bildgebungstechniken hat zudem unterschiedliche Spezifika, die den speziellen Indikationsbereich bestimmen.

Abstract

The functional and morphological intracoronary diagnostic adds significant informations to conventional coronary angiography and is therefore essential for modern interventional cardiology. The measurement of fractional flow reserve FFR allows a reliable assessment of the hemodynamic significance especially in intermediate coronary lesions and can facilitate the decision for or against revascularization procedures. High resolution tomographic images can be acquired by intravascular ultrasound (IVUS) and optical coherence tomography (OCT). These images provide valuable insights on plaque composition and lesion geometry and hereby impact the interventional strategy as well as the choice of balloons and implants.

Schlüsselwörter

FFR - IVUS - OCT - intravaskuläre Bildgebung

Key words

FFR - IVUS - OCT - intravascular imaging

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