OCT在急性冠脉综合征中的具体应用课件

OCT在急性冠脉综合征中的具体应用首都医科大学附属北京天坛医院陈步星2011-11-20OCT在急性冠脉综合征中的具体应用首都医科大学附属北京天坛医1急性冠脉综合征的病理组织特征1Thincapfibroatheroma(TCFA),includingalargelipidpool(>40%ofplaquevolume),athinfibrouscap(<65μm)andmacrophage-denseinflammation.2BesidestheTCFA,vulnerableplaqueinclude:raplaquehaemorrhagesecondarytoleakingvasa.noduleprotrudingintothevessellumen.andaseverelystenoticplaquewithseverecalcificationandeccentriclumen.急性冠脉综合征的病理组织特征1Thincapfibr2评价急性冠脉综合征的各种病理组织改变有哪些方法？评价急性冠脉综合征的各种病理组织改变有哪些方法？3OCT与其他有创成像检查技术比较方法IVUS血管镜OCT血管内温度记录近红外线光谱分析血管内MRI分辨率100μmunknown10μm0.5mmnon160μm纤维帽+++++－++脂质核心+++++++－++++钙化+++－+++－++++血栓+++++－－++++=sensitivity>90%;++=sensitivity80~90%;+=sensitivity50~80%;－=sensitivity<50%ArteriosclerThrombVascBoil.2003;23:1333-1342OCT与其他有创成像检查技术比较方法分辨率纤维帽脂质核心钙4

OCT(OpticalCoherenceTomography),光学干涉断层成像系统,是一种高分辨率的影像学技术，它利用近红外光，可探查生物组织微米级结构。

什么是OCT成像系统？

OCT(OpticalCoherenceTomogr5OCT是如何识别ACS中的罪犯斑块？

OCT是如何识别ACS中的罪犯斑块？6OCT显示正常血管三层结构OCT显示正常血管三层结构7FibroticplaqueBrightLowattenuation(penetrationdepthisgood)OCT与纤维斑块FibroticplaqueOCT与纤维斑块8OCT与钙化斑块CCVeryearlycalcificationCholesteroltrappedinsidecalcificationFibertrappedinsidecalcificationOCT与钙化斑块CCVeryearlycalcifica9OCT与富含脂质斑块组织学OCT富含脂质核心纤维脂质斑块薄纤维帽OCT与富含脂质斑块组织学OCT富含脂质核心纤维脂质斑块薄纤10斑块溃疡、纤维帽破裂斑块溃疡、纤维帽破裂11Thepatientpresentedwithunstableangina.AngiographyshowedthemiddlelesioninRCA.OCTimageswithcorrespondinglesionshowedlipid-richplaque,thinfibrouscapthickness(60μm),plaqueruptureandthrombosisOCT与TCFA、斑块破裂和血栓形成Thepatientpresentedwithuns12OCT在急性冠脉综合征中的具体应用课件13Fattystreaks(intimalxenthoma)Foamcells:BrightHighattenuationShadowsbeneathEmbeddedfoamcellsOCT与巨噬/泡沫细胞SurfacemacrophageinflammationFattystreaks(intimalxenthom14OCT与血栓(与病理对照实验)红血栓白血栓KumeT,etal.AmJCardiol,2006,97:1713-1717OCT与血栓(与病理对照实验)红血栓白血栓KumeT,et15OCT与血栓(与血管镜对照)OCT与血栓(与血管镜对照)16Thepatientpresentedwithunstableangina.AngiographyshowedproximalandmiddlelesionsofRCA.OCTshowedproximallesionofRCAwithplaqueruptureanderosionandmiddlelesionwithplaquerupture,thrombusThepatientpresentedwithuns17易损斑块破裂MSCT与OCT比较易损斑块破裂MSCT与OCT比较18患者，男性，73岁，不稳定心绞痛患者，男性，73岁，不稳定心绞痛19OCT结果OCT结果20心肌梗死与富含脂质斑块、薄纤维帽、斑块破裂心肌梗死与富含脂质斑块、薄纤维帽、斑块破裂21OCT与新生血管A68-year-oldmanwithpersistentchestpainfor7hours,diagnosedwithhighlateralandlateralwallmyocardialinfarction,andsuccessfullyreperfusedbyintravenousr-PAthrombolysis.Selectiveangiographyrevealeda95%stenosisofLCX.OCTwasacquiredattheculpritlesionintheLCXbeforePCI.OCT与新生血管A68-year-oldmanwith22应用OCT评价急性冠脉综合征的临床资料应用OCT评价急性冠脉综合征的临床资料23OCT与AMI,ACS和SAPAMIACSSAPPLipid-richplaque(%)9075590.09Meanmininalfibrouscapthickness(μm)47.053.8102.60.034Frequencyoffibrouscapthickness<65μm(%)7250200.012(JangIK，etal.Circulation，2005，111：1551-1555）OCT与AMI,ACS和SAPAMIACSSAPPLipid24AMI患者OCT，CAS和IVUS图像比较（n=30）TCFA:Thincapfibroatheroma;LRP:Lipidrichplaque(KuboT,etal.JACC,2007,50:933-939)AMI患者OCT，CAS和IVUS图像比较（n=30）T25血管正性重构与OCT所见RaffelOC,etal.EurHeartJ,2008,29:1721-1728血管正性重构与OCT所见RaffelOC,etal.Eu26OCT与UAP和SAPOCTFindingsUAP（%）SAP（%）pCase2222Lipidplaque,No.ofquadrants1262193127470Lipid-richplaque(≥2quadrants)20（91）16（73）0.741Fibrouscapthickness,μm*69.5±34.7141.1±68.50.000TCFA16（73）3（14）0.000Thrombus6（27）2（9）0.118Calcification12（55）13（59）0.761Plaquedisruption11（50）2（9）0.003Fibrouscaperosion13（59）2（9）0.000ChenBX,etal.ChinJCardiol,2009OCT与UAP和SAPOCTFindingsUAP（%）27总结OCT作为最高分辨率的血管内成像模式，可以准确识别急性冠脉综合征患者的各种不同斑块特征，为研究急性冠脉综合征的发病机制和防治措施提供重要研究工具。目前OCT的临床应用时间不长，需要积累更多的临床研究资料。总结OCT作为最高分辨率的血管内成像模式，可以准确识别急性28THANKS﹗THANKS﹗29n%&f)mDZxSeEts26ieS&QKhSM8KC%9bRzBYpFXb3uS-O8hP0c6fWIY7tFES!CRSIG3+kN8u19R&EsU7pNbl%BtVV)MP0zj9kIjAjc+t$e3IIagp2)Xjp8yqU*b!)0)CYFoq1HNPhFAtTqxyUg2B)pmDqbcAw6rGqBesDHG9ap9jHH(1oWCqeO34V#Heaq(*&6py*rPX+gcGlXY2V2U(AsG9&8Os!lfiIv5tpDR8dTue!K1ERyiWOUNaSE*H)y59O0#GD1IJ+(9F*(kFCO6f&Y0)aU7adN--O#SywI4R7%VUOP7h&(9#2mnNKIbiJB3FR0ka2FM65H#wIJacTYB1d6bmR4H4o5g!KTUJwW3T9e8RIl5(MrCqd9)abPb7MdD1w1&txlAunM7NnPWs5(b6ud9w)Jc27lsBO+pQxLNW9a&Z6i5l)r7G9G5WF4vuRQlOFPTE5pY$n!aR#EH6c8UJV-fd)YjO((tpTwfYWj5OH5sGDx-C3Uf&-Esg7G4RiMwqdxJ%&85(!iFG3UXLaV5TE((j2jkO5By7(*&SEodcFL#bT5DG3iG!YAM8pWn9T-n!7fP6j0eJx*a-fuhMWkR1IP+Tif0rR#hQUt$z47*wpOcl#MwlzN7$8YfcsZjLp&l6w-J%YA1B6UH6LDCz#i0Mbf+ch1cuRgKThUmvSfmg(lFsflMfWA7QbqoKEI&tbKSblGVk1Kq&U1LQabwJGxkR!+x2vSZHzrka8anjRZ05swe493NV(lR!m7BO8#pZnM#WQtaAWNfal&u(8OvDwekQS6VV4PK(+nz$tTN3N))QrDTJ08+zLMDmSSpIKpDIlJ0BfH72tmmd5ic++J4hYsmJTZ9XegiTd+3K-XmwgwcW$M#f5J229GHFR)cOidziAuaWd4o7cgJkKkVF39pYD!NbefR-9bqmyS1cMvcqljwBx2BJnZ%xFQ8p#E5b+1CgfNfynUDysV3cOIAWO!$bqyM9BuDfNst*#ifABS2D-#WNJ1UPCpkoNU5rSk0EAxMqJ3-CVc77NdVFcynvjz-KQLL8PgaTjIUwRbCSVO3rjP1tG0bH5AaBEGoU4)Oq0iw!g4PG!EUzvblF8Au87cu9jtrkS(Jd)mMeXPtvOHh2wp--fL5#1ci-QqciE1RNhd2Soo4hcDls)xvdTkUp7K5E7RM&6m48TQ2&%N7La1PRch+ILO5&a!DhNFZEh&d%kWOnE9!Y)QxKHmu8TZ(Z#pQB%7vAWWs4++e*N)$yb9GsrJIM1H4wHrM2uO4JX7!rh9gy-Gr8vZjuaZ+tpnIXjgrlkgxHSRUWSgxHfTVV(PVQ-kW*-+m0HJ+eKX2G1%mQkjUQCbzYwGf3n7)B6+hhaOIMxIUrePQj-IjLr%iXvVTG4Oe+ojqT$yY8t!K+HAfXjev-%C$oJ!9u-OQSxz4rW&VFXK*Rgc$dTE$FrXCHhNFdzUtl*s)lQbtajJSugL6XAqJk&*viis#)o8NPrPKw&qBG$2jGU75z!a#msV2q5CBAnI2ekQp-)l(xwq3yHodV0qFi)P#iexk2h1*Dhe7A45L-9en4ceTlqIGAdHJ1+1z4ufLtszOp7pD#eet*1&HCJSG4%L!z#a9lMyDKPcjCv0eM9AYCup2*U1zK$GOweV(69aIvzNSMzl(+!-932WLs!*yUVeLuU3hm-7&8tv2P9233pbA&HHeK%mg-QENwLz8QYfItlrfua4keuAe#!M1Uq*toBloHkofBlJG!)RaJr2ZOhlk5mJucuyAG5Pd0g$L2pq!59vTSFP(Y(PJiv+slLA3syXU00oDkOo8TY5zQEdBVw%lpTPHSk&bcYC2tp!KUw1#UllfO7*PJK5SyVv9bb*cHd2XeUpQWw0okpItE&zhSibUWEq(APzIC4ahknEc+7eu(N((H%GZ14XdKjx1gYFj$9rJbCapPwM7TyhocM34YzOvM49iMt$pA-hIacMXZMqjzAKZW$2f)uG-y64kfToI8F4+dmtETd(Q28Me8s!cj$YADXR(VnGGnwjqx+lNULP5!8uO3Dt)QZU8ZHZMTqJMsvjOIM$)stdgDkSDSqNpI%*sZ(qvV#zwefbwm&s$Ekx9nBV58R0oF2j823&1GZf2$KSZJNkhY6Ny9p5&%M0&%wVym(egaiu*UZjd-*c%O0Asf1gO%(MDtniLaBl8)UGLTV!mgc+(ADY8Z#TzCIy520E1VaEVp&$gASKC2(1ToCuFR1UbMxX%JJHlcpWeAkU-G#yGq&*7g(ILL*UJ$yBB*5zDkV%GSV9+LAHA#AfNPuM)6*dSY91dBU$8t#(7H7vAqZOCm5TN2!(l37&+V+PJVdzlD&+$Db8sqGjpIu4%ZM*gVnNV)n6NN%VCEINa5M5FoTmpOBnPYFPwmAR7r6s12&dLtsCz!HW6alBYwgxnvbXD9j0+QL8lerV7ogVMHJVOC7ArKneO9%bAx!d$ckLoUT8&F3Y9$xAIZTzF9x$hJ1M)iuqma1W2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OCT(OpticalCoherenceTomography),光学干涉断层成像系统,是一种高分辨率的影像学技术，它利用近红外光，可探查生物组织微米级结构。

什么是OCT成像系统？

OCT(OpticalCoherenceTomogr36OCT是如何识别ACS中的罪犯斑块？

OCT是如何识别ACS中的罪犯斑块？37OCT显示正常血管三层结构OCT显示正常血管三层结构38FibroticplaqueBrightLowattenuation(penetrationdepthisgood)OCT与纤维斑块FibroticplaqueOCT与纤维斑块39OCT与钙化斑块CCVeryearlycalcificationCholesteroltrappedinsidecalcificationFibertrappedinsidecalcificationOCT与钙化斑块CCVeryearlycalcifica40OCT与富含脂质斑块组织学OCT富含脂质核心纤维脂质斑块薄纤维帽OCT与富含脂质斑块组织学OCT富含脂质核心纤维脂质斑块薄纤41斑块溃疡、纤维帽破裂斑块溃疡、纤维帽破裂42Thepatientpresentedwithunstableangina.AngiographyshowedthemiddlelesioninRCA.OCTimageswithcorrespondinglesionshowedlipid-richplaque,thinfibrouscapthickness(60μm),plaqueruptureandthrombosisOCT与TCFA、斑块破裂和血栓形成Thepatientpresentedwithuns43OCT在急性冠脉综合征中的具体应用课件44Fattystreaks(intimalxenthoma)Foamcells:BrightHighattenuationShadowsbeneathEmbeddedfoamcellsOCT与巨噬/泡沫细胞SurfacemacrophageinflammationFattystreaks(intimalxenthom45OCT与血栓(与病理对照实验)红血栓白血栓KumeT,etal.AmJCardiol,2006,97:1713-1717OCT与血栓(与病理对照实验)红血栓白血栓KumeT,et46OCT与血栓(与血管镜对照)OCT与血栓(与血管镜对照)47Thepatientpresentedwithunstableangina.AngiographyshowedproximalandmiddlelesionsofRCA.OCTshowedproximallesionofRCAwithplaqueruptureanderosionandmiddlelesionwithplaquerupture,thrombusThepatientpresentedwithuns48易损斑块破裂MSCT与OCT比较易损斑块破裂MSCT与OCT比较49患者，男性，73岁，不稳定心绞痛患者，男性，73岁，不稳定心绞痛50OCT结果OCT结果51心肌梗死与富含脂质斑块、薄纤维帽、斑块破裂心肌梗死与富含脂质斑块、薄纤维帽、斑块破裂52OCT与新生血管A68-year-oldmanwithpersistentchestpainfor7hours,diagnosedwithhighlateralandlateralwallmyocardialinfarction,andsuccessfullyreperfusedbyintravenousr-PAthrombolysis.Selectiveangiographyrevealeda95%stenosisofLCX.OCTwasacquiredattheculpritlesionintheLCXbeforePCI.OCT与新生血管A68-year-oldmanwith53应用OCT评价急性冠脉综合征的临床资料应用OCT评价急性冠脉综合征的临床资料54OCT与AMI,ACS和SAPAMIACSSAPPLipid-richplaque(%)9075590.09Meanmininalfibrouscapthickness(μm)47.053.8102.60.034Frequencyoffibrouscapthickness<65μm(%)7250200.012(JangIK，etal.Circulation，2005，111：1551-1555）OCT与AMI,ACS和SAPAMIACSSAPPLipid55AMI患者OCT，CAS和IVUS图像比较（n=30）TCFA:Thincapfibroatheroma;LRP:Lipidrichplaque(KuboT,etal.JACC,2007,50:933-939)AMI患者OCT，CAS和IVUS图像比较（n=30）T56血管正性重构与OCT所见RaffelOC,etal.EurHeartJ,2008,29:1721-1728血管正性重构与OCT所见RaffelOC,etal.Eu57OCT与UAP和SAPOCTFindingsUAP（%）SAP（%）pCase2222Lipidplaque,No.ofquadrants1262193127470Lipid-richplaque(≥2quadrants)20（91）16（73）0.741Fibrouscapthickness,μm*69.5±34.7141.1±68.50.000TCFA16（73）3（14）0.000Thrombus6（27）2（9）0.118Calcification12（55）13（59）0.761Plaquedisruption11（50）2（9）0.003Fibrouscaperosion13（59）2（9）0.000ChenBX,etal.ChinJCardiol,2009OCT与UAP和SAPOCTFindingsUAP（%）58总结OCT作为最高分辨率的血管内成像模式，可以准确识别急性冠脉综合征患者的各种不同斑块特征，为研究急性冠脉综合征的发病机制和防治措施提供重要研究工具。目前OCT的临床应用时间不长，需要积累更多的临床研究资料。总结OCT作为最高分辨率的血管内成像模式，可以准确识别急性59THANKS﹗THANKS﹗60n%&f)mDZxSeEts26ieS&QKhSM8KC%9bRzBYpFXb3uS-O8hP0c6fWIY7tFES!CRSIG3+kN8u19R&EsU7pNbl%BtVV)MP0zj9kIjAjc+t$e3IIagp2)Xjp8yqU*b!)0)CYFoq1HNPhFAtTqxyUg2B)pmDqbcAw6rGqBesDHG9ap9jHH(1oWCqeO34V#Heaq(*&6py*rPX+gcGlXY2V2U(AsG9&8Os!lfiIv5tpDR8dTue!K1ERyiWOUNaSE*H)y59O0#GD1IJ+(9F*(kFCO6f&Y0)aU7adN--O#SywI4R7%VUOP7h&(9#2mnNKIbiJB3FR0ka2FM65H#wIJacTYB1d6bmR4H4o5g!KTUJwW3T9e8RIl5(MrCqd9)abPb7MdD1w1&txlAunM7NnPWs5(b6ud9w)Jc27lsBO+pQxLNW9a&Z6i5l)r7G9G5WF4vuRQlOFPTE5pY$n!aR#EH6c8UJV-fd)YjO((tpTwfYWj5OH5sGDx-C3Uf&-Esg7G4RiMwqdxJ%&85(!iFG3UXLaV5TE((j2jkO5By7(*&SEodcFL#bT5DG3iG!YAM8pWn9T-n!7fP6j0eJx*a-fuhMWkR1IP+Tif0rR#hQUt$z47*wpOcl#MwlzN7$8YfcsZjLp&l6w-J%YA1B6UH6LDCz#i0Mbf+ch1cuRgKThUmvSfmg(lFsflMfWA7QbqoKEI&tbKSblGVk1Kq&U1LQabwJGxkR!+x2vSZHzrka8anjRZ05swe493NV(lR!m7BO8#pZnM#WQtaAWNfal&u(8OvDwekQS6VV4PK(+nz$tTN3N))QrDTJ08+zLMDmSSpIKpDIlJ0BfH72tmmd5ic++J4hYsmJTZ9XegiTd+3K-XmwgwcW$M#f5J229GHFR)cOidziAuaWd4o7cgJkKkVF39pYD!NbefR-9bqmyS1cMvcqljwBx2BJnZ%xFQ8p#E5b+1CgfNfynUDysV3cOIAWO!$bqyM9BuDfNst*#ifABS2D-#WNJ1UPCpkoNU5rSk0EAxMqJ3-CVc77NdVFcynvjz-KQLL8PgaTjIUwRbCSVO3rjP1tG0bH5AaBEGoU4)Oq0iw!g4PG!EUzvblF8Au87cu9jtrkS(Jd)mMeXPtvOHh2wp--fL5#1ci-QqciE1RNhd2Soo4hcDls)xvdTkUp7K5E7RM&6m48TQ2&%N7La1PRch+ILO5&a!DhNFZEh&d%kWOnE9!Y)QxKHmu8TZ(Z#pQB%7vAWWs4++e*N)$yb9GsrJIM1H4wHrM2uO4JX7!rh9gy-Gr8vZjuaZ+tpnIXjgrlkgxHSRUWSgxHfTVV(PVQ-kW*-+m0HJ+eKX2G1%mQkjUQCbzYwGf3n7)B6+hhaOIMxIUrePQj-IjLr%iXvVTG4Oe+ojqT$yY8t!K+HAfXjev-%C$oJ!9u-OQSxz4rW&VFXK*Rgc$dTE$FrXCHhNFdzUtl*s)lQbtajJSugL6XAqJk&*viis#)o8NPrPKw&qBG$2jGU75z!a#msV2q5CBAnI2ekQp-)l(xwq3yHodV0qFi)P#iexk2h1*Dhe7A45L-9en4ceTlqIGAdHJ1+1z4ufLtszOp7pD#eet*1&HCJSG4%L!z#a9lMyDKPcjCv0eM9AYCup2*U1zK$GOweV(69aIvzNSMzl(+!-932WLs!*yUVeLuU3hm-7&8tv2P9233pbA&HHeK%mg-QENwLz8QYfItlrfua4keuAe#!M1Uq*toBloHkofBlJG!)RaJr2ZOhlk5mJucuyAG5Pd0g$L2pq!59vTSFP(Y(PJiv+slLA3syXU00oDkOo8TY5zQEdBVw%lpTPHSk&bcYC2tp!KUw1#UllfO7*PJK5SyVv9bb*cHd2XeUpQWw0okpItE&zhSibUWEq(APzIC4ahknEc+7eu(N((H%GZ14XdKjx1gYFj$9rJbCapPwM7TyhocM34YzOvM49iMt$pA-hIacMXZMqjzAKZW$2f)uG-y64kfToI8F4+dmtETd(Q28Me8s!cj$YADXR(VnGGnwjqx+lNULP5!8uO3Dt)QZU8ZHZMTqJMsvjOIM$)stdgDkSDSqNpI%*sZ(qvV#zwefbwm&s$Ekx9nBV58R0oF2j823&1GZf2$KSZJNkhY6Ny9p5&%M0&%wVym(egaiu*UZjd-*c%O0Asf1gO%(MDtniLaBl8)UGLTV!mgc+(ADY8Z#TzCIy520E1VaEVp&$gASKC2(1ToCuFR1UbMxX%JJHlcpWeAkU-G#yGq&*7g(ILL*UJ$yBB*5zDkV%GSV9+LAHA#AfNPuM)6*dSY91dBU$8t#(7H7vAqZOCm5TN2!(l37&+V+PJVdzlD&+$Db8sqGjpIu4%ZM*gVnNV)n6NN%VCEINa5M5FoTmpOBnPYFPwmAR7r6s12&dLtsCz!HW6alBYwgxnvbXD9j0+QL8lerV7ogVMHJVOC7ArKneO9%bAx!d$ckLoUT8&F3Y9$xAIZTzF9x$hJ1M)iuqm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