OCT(我的课件).ppt

ApplicationofOCTinpercutaneouscoronaryintervention Liu yingwu content BackgroundDefinitionandmechanismHistoryOCTVsIVUSImageidentificationApplicationinPCISummary Background TherearelotsofmethodstodetectthelesionsofcoronaryarteryForalongtime coronaryangiography CAG isregardedasthe goldenstandard foradiagnosisofcoronaryarterydisease CAD But infact itisnotalwaystrue Hereisanexample FromCAG thereseemsnodifferenceinsiteAandsiteBButIVUSgivesusanotheraspect So whatyouseeisnotalwaystrue IntraVascularUltrasoundSystem OpticalCoherenceTomography Sometimes wehavetolookintothevessel Definitionandmechanism OCT OpticalCoherenceTomographyMechanism somewhatlikeRadarnearinfraredrayweekcoherentmechanismreflectedwave History OCTisclinicallyusedforovertenyearseversinceitsbeingintroducedformedicalpurposein1991MainlyusedinthedepartmentofophthalmologyNowiswidelyused component BalloonPressure Wire Balloon masterstation IVUSVsOCT GREYpictureCOLORPicture IVUS OCT Highervalidity IVUSVsOCT IVUS OCT Easiertoidentify OCTVsIVUS 1 OCTVsIVUS 2 OCTVsIVUS 3 Imageidentification Normalthreelayerstructure fibrousplaque Opticsbiopsy fibro calcifiedplaque calcifiedplaque Rich lipidplaque thincapfibro atheroma TCFA stableplaqueandvulnerablePlaque Stableplaque vulnerablePlaque Largelipidcore thicknessoffabriccaponly50 mAndeasytorupture 80y o M AnteroseptalAMI Erosion Ulceration Thrombus WhiteThrombus Redthrombus Red whitethrombus KumeT AkasakaT etal AmJCardiol97 1713 1717 2006 Redthrombus Protrusionmasswithshadow Protrusionmasswithoutshadow Protrusionmasswith withoutshadow Whitethrombus Mixedthrombus KuboT AkasakaT etal JAmCollCardiol50 933 939 2007 Stent ApplicationinPCI DetectvulnerablePlaqueAssessmentofinstantresultsofstentimplantationPost stentfollowup ApplicationinPCI DetectvulnerablePlaque Thin capfibroatheroma TCFA PossibilitytoidentifyTCFAhasbeendemonstratedbyseveralpilotstudies OCTcanmeasurethethicknessoffibrouscapexactly ApplicationinPCI DetectvulnerablePlaque Plaquerupture fissureoffibriccap OCTcanfindatinyfissureofintima ApplicationinPCI DetectvulnerablePlaque InvivocomparisonofOCT IVUSandangioscopyinassessingculpritlesionsin30AMIpatients Kuboetal JAmCollCardiol2007 50 933 9 Incidence 73 Incidence 47 Incidence 40 Incidence 23 Incidence 3 Incidence 0 ApplicationinPCI DetectvulnerablePlaque Macrophages ApplicationinPCI Assessmentofinstantresultsofstent under expansionandmalappositionofstent Assessmentofstentapposition A B Assessmentofstentmal apposition Thegapbetweenstentandintima 200 m indicatestentmalapposition Tissueprolapse Lacerationofintima In stentlacerationofintima Lacerationofintimaattheedgeofstent ApplicationinPCI Post stentfollowup Assessmentofcoverageofneointima Latemalappositionofstent Positiveremodelling Remodelingafterstentimplantation Negativeremodeling Positiveremodeling Latein stentthrombosisformation Stentmalapposition Tissueprotrusion Inconsistentstrutdistribution Stentedgedissection Summary OCTgivesusmoreimformationaboutvesselwallthanCAG assistustoassessthestabilityofplaqueOCTcanhelpustoidentifythevulnerablePlaque detectmacrophage thisishelpfulforourlinicaldecision andissuperiortoIVUSOCTcanalsoprovideimformationaboutinstantresultsandfollow upeffectsafterstentimplantationBut itneedtoblockadethebloodstream resultinmyocardiumischemiaandnotea