冠状动脉影像的最新进展课件

第5回日中心血管 Kinki University, School of Medicine 2009/10/12 Recent Progress in Coronary Imaging Shunichi Miyazaki, MD, PhD Professor and Chairman, Division of Cardiology, Department of Internal Medicine Kinki University School of Medicine 第5回日中心血管 Kinki University, School of Medicine 2009/10/12 Complex anatomy is difficult to understand in 3D manner. Information regarding coronary plaque, per se, is essential. Angiography shows 2D information as a silhouette 第5回日中心血管 Kinki University, School of Medicine 2009/10/12 Atheromatous plaque Coronary imaging should be oriented to obtain direct information of plaque. 第5回日中心血管 Kinki University, School of Medicine 2009/10/12 Intra-Vascular UltraSound （IVUS） since early 90 第5回日中心血管 Kinki University, School of Medicine 2009/10/12 Mechanical ScanLinear Scan Boston ScientificBoston Scientific TERUMOTERUMO VOLCANOVOLCANO 第5回日中心血管 Kinki University, School of Medicine 2009/10/12 Plaque Rupture Lipid Core Dissection Lipid Core Dissection 第5回日中心血管 Kinki University, School of Medicine 2009/10/12 80 degree Calcification Calcification Calcification D IVUS 第5回日中心血管 Kinki University, School of Medicine 2009/10/12 10mm 10mm DistalStenosisProximal 8.7mm222.6mm2 16.4mm2 Ostium Vascular Remodeling 第5回日中心血管 Kinki University, School of Medicine 2009/10/12 Virtual Histology 第5回日中心血管 Kinki University, School of Medicine 2009/10/12 Angioscopy since early 90 第5回日中心血管 Kinki University, School of Medicine 2009/10/12 Angioscopy catheter Vecmova (Clinical Supply) Catheter shaft 4.5Fr，balloon part 5.0Fr Pixels：3000 Visual angle：70 degree Depth：2mm lens Balloon 第5回日中心血管 Kinki University, School of Medicine 2009/10/12 Normal endothelium 第5回日中心血管 Kinki University, School of Medicine 2009/10/12 Yellow Plaque White Thin yellow YellowThick yellow 第5回日中心血管 Kinki University, School of Medicine 2009/10/12 C C D D B B A A Thrombus ：White thrombus ： few seconds after, white plaque increased along with red thrombus attachment C ：Mixed thrombus ：Red thrombus 第5回日中心血管 Kinki University, School of Medicine 2009/10/12 AMI case 第5回日中心血管 Kinki University, School of Medicine 2009/10/12 IVUS 第5回日中心血管 Kinki University, School of Medicine 2009/10/12 Angioscopy 第5回日中心血管 Kinki University, School of Medicine 2009/10/12 Plaque rupture AngioscopyIVUS dissection Lipid core dissection Mixed thrombus 64 yo, man, Anterior MI. 第5回日中心血管 Kinki University, School of Medicine 2009/10/12 Non Q AMI case 第5回日中心血管 Kinki University, School of Medicine 2009/10/12 IVUS 第5回日中心血管 Kinki University, School of Medicine 2009/10/12 Angioscopy 第5回日中心血管 Kinki University, School of Medicine 2009/10/12 Errosion AngioscopyIVUS Mural thrombus Yellow plaque Calcification 第5回日中心血管 Kinki University, School of Medicine 2009/10/12 Inferior AMI, 30 days after emergent PCI 第5回日中心血管 Kinki University, School of Medicine 2009/10/12 Inferior AMI, 30 days after emergent PCI 第5回日中心血管 Kinki University, School of Medicine 2009/10/12 Optical coherrence tomography (OCT) 第5回日中心血管 Kinki University, School of Medicine 2009/10/12 C DA B A) Light Lab OCT B) monitor C) image wire D) occlusion balloon OCT equippment 第5回日中心血管 Kinki University, School of Medicine 2009/10/12 第5回日中心血管 Kinki University, School of Medicine 2009/10/12 第5回日中心血管 Kinki University, School of Medicine 2009/10/12 第5回日中心血管 Kinki University, School of Medicine 2009/10/12 第5回日中心血管 Kinki University, School of Medicine 2009/10/12 Immediately after Cypher implantation 第5回日中心血管 Kinki University, School of Medicine 2009/10/12 8 months after Cypher implant 第5回日中心血管 Kinki University, School of Medicine 2009/10/12 周囲境界不明瞭， 内部均一高輝度領域 周囲境界明瞭, 内部 主不均一低輝度領域 周囲境界不明瞭，内 部主不均一低輝度領域 L Lipid rich plaquecalcification F Fibrosis C F C L OCT images 500m 500m 500m 第5回日中心血管 Kinki University, School of Medicine 2009/10/12 OCT CD68 250 m B A OCT can detect macrophages 第5回日中心血管 Kinki University, School of Medicine 2009/10/12 BMS 17MBMS 7M Intimal hyperplasia after Stenting 第5回日中心血管 Kinki University, School of Medicine 2009/10/12 resolustiondepthfibrosislipidinflammationcalc.thrombus IVUS100mgood AngioscopyN/Abad OCT10mbad ：sen sitivity90%，：80