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Einsatz der optischen Kohärenztomographie in der interventionellen Kardiologie

Methodische Grundlagen und klinische Anwendung

Use of optical coherence tomography in interventional cardiology

Methodological principles and clinical applications

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  • Published:
Der Kardiologe Aims and scope

Zusammenfassung

Die optische Kohärenztomographie (OCT) ist eine innovative intrakoronare Bildgebungstechnik, die eine hochauflösende Darstellung der Koronarstruktur und -morphologie ermöglicht. Dadurch werden eine genaue Darstellung der Koronargefäßwand und zur Koronarintervention (perkutane Koronarintervention [PCI]) eine differenzierte Festlegung des interventionellen Behandlungsziels, ein exaktes Stentsizing und eine Beurteilung des PCI-Resultats möglich. Der vorliegende Beitrag fasst technisch-methodische Grundlagen der OCT-Bildgebung, Grundlagen der OCT-Bildinterpretation, den Einsatz der OCT-Technik zur Koronarintervention und die dem Verfahren aktuell zugrunde liegende Studienevidenz zusammen.

Abstract

Optical coherence tomography (OCT) is a novel intracoronary imaging technique with high spatial resolution. This imaging technology enables a detailed characterization of the coronary artery wall, thereby providing complementary information to conventional coronary angiography for OCT-guided percutaneous coronary interventions (PCI). The use of OCT facilitates optimal stent sizing, precise identification of the stent landing zones and helps to recognize procedural complications, such as edge dissection, tissue prolapse, stent malapposition and underexpansion. The present report reviews the technical principles, analysis algorithms, image interpretation and current evidence for OCT-guided PCI.

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Authors and Affiliations

  1. Medizinische Klinik für Kardiologie, Charité Universitätsmedizin Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, 12203, Berlin, Deutschland

    V. S. Schneider, Y. Abdelwahed, M. Riedel, F. Böhm, J. K. Steiner, K. Blum, C. Seppelt, L. Steinbeck, B. E. Stähli, A. Lauten, U. Landmesser &  D. M. Leistner

  2. Deutsches Zentrum für Herzkreislaufforschung (DZHK), Standort Berlin, 10115, Berlin, Deutschland

    V. S. Schneider, J. K. Steiner, L. Steinbeck, B. E. Stähli, A. Lauten, U. Landmesser &  D. M. Leistner

  3. Berlin Institute of Health (BIH), 10117, Berlin, Deutschland

    Y. Abdelwahed, L. Steinbeck, U. Landmesser &  D. M. Leistner

Authors
  1. V. S. Schneider
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  2. Y. Abdelwahed
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  3. M. Riedel
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  4. F. Böhm
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  5. J. K. Steiner
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  6. K. Blum
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  7. C. Seppelt
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  9. B. E. Stähli
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  10. A. Lauten
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  11. U. Landmesser
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Corresponding author

Correspondence to D. M. Leistner.

Ethics declarations

Interessenkonflikt

Y. Abdelwahed, A. Lauten, U. Landmesser und D.M. Leistner geben an, Sprecherhonorare, Honorar für Beratertätigkeiten und/oder Forschungsunterstützung von Abbott Vascular/Abbott St. Jude erhalten zu haben. S. Schneider, M. Riedel, F. Böhm, J.K. Steiner, K. Blum , C. Seppelt , L. Steinbeck und B.E. Stähli geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Additional information

Redaktion

P. Stawowy, Berlin

CME-Fragebogen

CME-Fragebogen

Wie hoch ist die Auflösung der OCT?

1–2 μm

15–20 μm

50–100 μm

100–200 μm

250–500 μm

Wie groß ist die Gefäßlänge, die pro OCT-Rückzug maximal gescannt werden kann?

34 mm

45 mm

56 mm

75 mm

95 mm

Wie sind Fibroatherome im OCT-Bild zu erkennen?

Signalreicher scharf begrenzter Kern bedeckt von einer signalreichen Kappe

Signalarmer scharf begrenzter Kern bedeckt von einer signalarmen Kappe

Signalreicher unscharf begrenzter Kern bedeckt von einer signalarmen Kappe

Signalreicher unscharf begrenzter Kern bedeckt von einer signalreichen Kappe

Signalarmer unscharf begrenzter Kern bedeckt von einer signalreichen Kappe

Welche Morphologie einer Koronarplaque ist häufig morphologisches Korrelat eines akuten Koronarsyndroms (ACS)?

Fibröse Plaque

„Lipid arc“

„Thin-cap fibroatheroma“ (TCFA)

Cholesterinkristalle

Fibrokalzifizierte Plaque

Welche Pathologie lässt sich bei akuten Stentthrombosen in der OCT am häufigsten finden?

TCFA

„Edge dissection“

Stentunterexpansion

Stentüberexpansion

„Calcified noduli“

Wie hoch ist die Eindringtiefe der OCT?

3–4 mm

4–8 mm

1–2 mm

10–20 µm

200–400 µm

Was versteht man unter der MSA?

Minimal Stent-Area

Minimal Strut-Area

Mean Stent-Area

Maximal Strut-Area

Mean Strut-Area

Die OCT ermöglicht eine genaue Kontrolle des Ergebnisses nach PCI. Welcher Befund muss nicht immer zwingend korrigiert werden?

Stentthrombose

Relevante Stentunterexpansion

Signifikante Stentmalapposition

„Edge dissection“

Relevante Stentunterexpansion und Stentmalapposition

Die korrekte Wahl der Stentgröße ist elementar, um ein optimales Langzeitoutcome für den Patienten zu erzielen. Wie können Sie mithilfe der OCT die richtige Stentgröße ermitteln?

Der kleinste mittlere Diameter (gemessen von der Lamina elastica externa) im distalen Referenzsegment bestimmt die Stentgröße.

Der kleinste mittlere Diameter (gemessen von der Lamina elastica externa) im proximalen Referenzsegment bestimmt die Stentgröße.

Der größte mittlere Diameter (gemessen von der Lamina elastica externa) im proximalen Referenzsegment bestimmt die Stentgröße.

Der kleinste mittlere Diameter (gemessen von der Lamina elastica externa) von jeweils proximalem und distalem Referenzsegment bestimmt die Stentgröße.

Der größte mittlere Diameter (gemessen von der Lamina elastica externa) von jeweils proximalem und distalem Referenzsegment bestimmt die Stentgröße.

Eine zu behandelnde Koronarläsion im Bereich einer fibrokalzifizierten Plaque impliziert bei der PCI ...

Möglichkeit zur primären Stentimplantation.

Absetzen der Statintherapie.

Stentgröße möglichst klein zu wählen.

Bereitschaft zur Läsionspräparation (Rotablation, Non-Compliant-Ballons).

Gabe eines Lysebolus intrakoronar.

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Schneider, V.S., Abdelwahed, Y., Riedel, M. et al. Einsatz der optischen Kohärenztomographie in der interventionellen Kardiologie. Kardiologe 12, 153–166 (2018). https://doi.org/10.1007/s12181-018-0234-9

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