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Kardiologie up2date 2020; 16(03): 223-238
DOI: 10.1055/a-0917-2551
Koronare Herzkrankheit (KHK)

Optische Kohärenztomografie und intravaskulärer Ultraschall

Intrakoronare Bildgebungsverfahren bei Koronarinterventionen
Sebastian Reith
,
Mathias Burgmaier
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Mit der Koronarangiografie erfasst man das Ausmaß und den Schweregrad einer KHK, stellt in Kombination mit hämodynamischen Messungen die Indikation zur Intervention und beurteilt deren Ergebnis. Um jedoch eine adäquate Strategie festzulegen oder das Ergebnis der Stentimplantation akut zu beurteilen, werden in der interventionellen Kardiologie zunehmend der intravaskuläre Ultraschall (IVUS) und die optische Kohärenztomografie (OCT) bei perkutanen Koronarinterventionen (PCI) eingesetzt.
Kernaussagen

  • Die intrakoronare Bildgebung ermöglicht eine sehr detaillierte Bewertung der koronaren Stentimplantation und möglicher prozeduraler Komplikationen.

  • Stentoptimierung bedeutet die Erfassung der Stentexpansion und -apposition.

  • Die intravaskuläre Bildgebung kann prozedurale Komplikationen nach Stentimplantation nachweisen: Stentranddissektionen, Gewebs- oder Thrombusprotrusionen, Stentfraktur, Plaqueshift oder Koronarspasmus.

  • OCT und IVUS unterscheiden sich technisch und im idealen Anwendungsspektrum. Da beide Verfahren unterschiedliche Stärken und Schwächen haben und gute randomisierte Daten über das tatsächliche Outcome der Patienten derzeit noch fehlen, kann eine komplementäre Anwendung beider Methoden in der klinischen Praxis durchaus sinnvoll sein.

  • Interventionelle Kardiologen sollten mit mindestens einer der beiden intrakoronaren Bildgebungsverfahren IVUS oder OCT vertraut sein und eines der beiden vermehrt vor allem im Rahmen komplexer Koronarinterventionen einsetzen.

Schlüsselwörter

optische Kohärenztomografie - intravaskulärer Ultraschall - Koronarintervention - intrakoronare Bildgebung


Publication History

Article published online:
10 September 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Stuttgart · New York

 

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