冠状动脉成像在慢性全闭塞中的作用:应用与未来的可能性

IF 2.4 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Giuseppe Panuccio, Youssef S Abdelwahed, Nicole Carabetta, Ulf Landmesser, Salvatore De Rosa, Daniele Torella
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引用次数: 0

摘要

慢性全闭塞(CTO)是冠状动脉疾病(CAD)中的一个难题。在接受冠状动脉造影检查的患者中,CTOS 的发病率很高,这凸显了对有效诊断和治疗策略的需求。冠状动脉造影虽然必不可少,但对病变形态、血管走向和心肌存活能力的了解却很有限。相比之下,冠状动脉成像技术--包括光学相干断层扫描(OCT)、血管内超声(IVUS)和冠状动脉计算机断层扫描血管造影(CCTA)--可全面了解 CTO 经皮冠状动脉介入治疗(PCI)的每个阶段。尽管在 CTO 经皮冠状动脉介入治疗中证据较少且存在一些局限性,但 OCT 仍有助于评估斑块形态和支架优化。IVUS 具有更深的穿透力,可管理近端冠状动脉帽的情况并指导内膜下导航。CCTA 可提供无创、三维的冠状动脉解剖视图,可精确评估心肌风险和详细的手术规划。尽管存在各自的局限性,但这些成像模式提高了 CTO-PCI 的成功率,从而减少了手术并发症和长期并发症,改善了患者的预后。CTO 管理的未来取决于进一步的技术进步,包括混合成像、人工智能(AI)集成和改进的融合成像。这些创新有望提高手术的精确性和干预的个性化,最终改善复杂冠状动脉疾病患者的治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The Role of Coronary Imaging in Chronic Total Occlusions: Applications and Future Possibilities.

Chronic total occlusions (CTOs) represent a challenging scenario in coronary artery disease (CAD). The prevalence of CTOS in patients undergoing coronary angiography underscores the need for effective diagnostic and therapeutic strategies. Coronary angiography, while essential, offers limited insights into lesion morphology, vessel course, and myocardial viability. In contrast, coronary imaging techniques-including optical coherence tomography (OCT), intravascular ultrasound (IVUS), and coronary computed tomography angiography (CCTA)-provide comprehensive insights for each stage of CTO percutaneous coronary intervention (PCI). OCT facilitates the assessment of plaque morphology and stent optimization, despite low evidence and several limitations in CTO-PCI. IVUS offers deeper penetration, allowing managing proximal cap scenarios and guiding subintimal navigation. CCTA provides a non-invasive, three-dimensional view of coronary anatomy, enabling the precise evaluation of myocardial mass at risk and detailed procedural planning. Despite their individual limitations, these imaging modalities have enhanced the success rates of CTO-PCI, thus reducing procedural and long-term complications and improving patient outcomes. The future of CTO management lies in further technological advancements, including hybrid imaging, artificial intelligence (AI) integration, and improved fusion imaging. These innovations promise to refine procedural precision and personalize interventions, ultimately improving the care of patients with complex coronary artery disease.

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来源期刊
Journal of Cardiovascular Development and Disease
Journal of Cardiovascular Development and Disease CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
2.60
自引率
12.50%
发文量
381
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