Intravascular ultrasound and optical coherence tomography imaging of coronary atherosclerosis

Abstract

Invasive imaging modalities, in particular intravascular ultrasound (IVUS) and optical coherence tomography (OCT), have become established tools for the in vivo study of coronary atherosclerosis. Their use in clinical studies has confirmed histopathological observations that certain important plaque features, such as thin fibrous caps and large lipid cores, are associated with plaque rupture, the precipitating event for the majority of myocardial infarctions. Serial imaging studies have also successfully been used for the evaluation of potential disease modifying pharmacological agents. Recent prospective IVUS studies have confirmed specific baseline imaging features associated with subsequent adverse clinical outcomes, although absolute event rates were too low for clinical utility. Development of hybrid IVUS-OCT imaging or integration of novel techniques, including near-infrared spectroscopy, plaque structural and endothelial shear stress, have great potential to improve our current ability to identify and stratify atheromatous plaques at risk of rupture.

Infarto agudo de miocardio sin enfermedad coronaria ateroesclerótica obstructiva

“…En caso de sospechar disección coronaria o disrupción de placas ateroscleróticas, lo ideal sería la realización de imágenes intravasculares como el IVUS o la OCT, procesos concomitantes a la realización de la coronariografía. En nuestro medio éstas herramientas no están disponibles en todos los sitios, pero sí la angio-TAC coronaria, que puede ser útil (21,32).…”

“…Un área de LGE subendocardico sugiere isquemia, si es epicárdico, sugiere cardiomiopatía, y en el caso de no tener apariencia isquémica puede sugerir miocarditis o desordenes infiltrativos. (26,32). En un estudio en el que se realizó RMC en 153 pacientes con MINOCA se encontró que el 67 % de ellos fueron normales, el 19 % tenían signos de necrosis miocárdica y el 7 % signos de miocarditis, con lo cual se comprobó su utilidad para diferenciar miocarditis, necrosis miocárdica y miocardio normal.…”

Intracoronary Imaging

“…OCT clearly detects intima proliferation as a high backscattered thick layer facing the lumen, surrounded by the intensely reflective stent struts. Histological variations within the neointima result in a complex classification of its appearance (homogeneous or heterogeneous) (figure 5A, B) 7 11…”

Recent Advances in Managing Atherosclerosis via Nanomedicine

“…Development of atherosclerosis is slow, giving rise to a theoretically long window of opportunity for diagnosis. Owing to the asymptotic nature of pathogenesis, noninvasive accurate classification of atherosclerotic plaques with high spatial resolution and sensitivity remains to be desired, so that patients with high risks of plaque rupture may be identified for immediate treatment and frequent monitoring. On the currently available intervention options for atherosclerosis, coronary angioplasty and stent insertion are common, but restenosis occurs at the intervention site for up to 50% of CVD patients undergoing angioplasty within 6 months of the procedure .…”