冠状动脉内影像学及功能评价研究学习课件

冠状动脉内

影像学及功能评价

Coronary angiogram

QCA DS 40-70%

Evaluation of the lesion

Common questions for the intermediate lesion:

1.As a physiologist: what’s the effect of this stenosis on

coronary blood flow and myocardial function?

2.As a clinician: Is this lesion responsible for the patient’s

symptoms?

3.As an interventionalist: Will revascularization of this artery

improve the patient’s clinical outcome?

Functional test:

Treadmill, SPECT(MPI), UCG, MRI

Upper ：Stress MPI Low：Rest MPI

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Stress

Rest

Stress

Stress

Rest

Rest

Evidence of ischemia

Functional test: CFR, FFR VH Morphology ：IVUS, OCT Aortic Pressure = 89 mm Hg

FFR = 40/89 = 0.45

Coronary Pressure = 40 mm Hg Intracoronary imaging and functional test in Cath. Lab

Atheroma morphology

Soft plaque Fibrous plaque Calcified plaque

Thrombus

Intermediate lesion

Criteria for “significant” lesion of proximal LAD,LCX and RCA:

☐MLA<4mm2

☐Plaque burden>70%

EEM-csa=14.2mm2

Lumen-csa=3.8mm2

Plaque burden=(14.2-3.8)/14.2

=73.2%

Vulnerable plaque Characteristics of vulnerable plaue in IVUS：☐Area of echolucent zone>1mm2；

☐Echolucent area/plaque area >20％；

☐Thickness of fibrous cap <0.7mm 。

Ge et al, Heart, 1999

baseline 6m FU

Okazaki S, et al. Circulation. 2004; 110: 1061-686m FU

baseline Control atorvastatin ESTABLISH Trial: atorvastatin 20mg Plaque regression evaluated with IVUS

Ostial lesion

Preparation -Lesion Evaluation by IVUS IVUS guidance is a MUST for left mains It helps for building up the strategy and determining the type and size of devices I will need.1.

Estimate left main length and size (LM always bigger than you think)2.Give information whether or not there is calcification 3.Evaluate plaque volume and distribution

!

Lesion:

Lesion:

IVUS Criteria of significant lesions ➢For LM lesions:

Lcsa<6.0mm2, or MLD <3.0mm

➢For Proximal segment of others(LAD/LCX/RCA) Lcsa<4.0mm 2

EEM

Intimal edge

Male, 57 yrs, 6m after stenting of LAD,RCA, Stable angina

Use of IVUS in Intervention of LM Lesion

MLA 7.2mm 2

Plaque burden 63%

MLA 5.3mm 2

Plaque burden 78%MLA 2.7mm 2Plaque burden 80.6%

Use of IVUS in Intervention of LM Lesion

Use of IVUS in Intervention of LM Lesion MLA 13.5mm 2

IVUS指导左主干病变介入治疗Impact of IVUS Guidance on All-Cause Mortality

After LMCA DES Implantation (n=805)

SJ Park et al. TCT 2007