OCT在急性冠脉综合征中的具体应用课件.ppt
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2011-11-20,急性冠脉综合征的病理组织特征,1 Thin cap fibroatheroma(TCFA),including a large lipid pool(40%of plaque volume),a thin fibrous cap(65m)and macrophage-dense inflammation.2 Besides the TCFA,vulnerable plaque include:a ruptured or eroded plaque with subocclusive thrombus and early organization.an erosion-prone plaque with a proteoglycan matrix in a smooth muscle cell-rich plaque.intraplaque haemorrhage secondary to leaking vasa.nodule protruding into the vessel lumen.and a severely stenotic plaque with severe calcification and eccentric lumen.,评价急性冠脉综合征的各种病理组织改变有哪些方法？,OCT与其他有创成像检查技术比较,Arterioscler Thromb Vasc Boil.2003;23:1333-1342,OCT(Optical Coherence Tomography),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是如何识别ACS中的罪犯斑块？,OCT显示正常血管三层结构,Fibrotic plaqueBrightLow attenuation(penetration depth is good),OCT与纤维斑块,OCT与钙化斑块,C,C,Very early calcification,Cholesterol trapped inside calcification,Fiber trapped inside calcification,OCT与富含脂质斑块,组织学,OCT,富含脂质核心,纤维脂质斑块,薄纤维帽,斑块溃疡、纤维帽破裂,The patient presented with unstable angina.Angiography showed the middle lesion in RCA.OCT images with corresponding lesion showed lipid-rich plaque,thin fibrous cap thickness(60m),plaque rupture and thrombosis,OCT与TCFA、斑块破裂和血栓形成,Fatty streaks(intimal xenthoma),Foam cells:Bright High attenuationShadows beneath,Embedded foam cells,OCT与巨噬/泡沫细胞,Surface macrophage inflammation,OCT与血栓(与病理对照实验),红血栓,白血栓,Kume T,et al.Am J Cardiol,2006,97:1713-1717,OCT 与血栓(与血管镜对照),The patient presented with unstable angina.Angiography showed proximal and middle lesions of RCA.OCT showed proximal lesion of RCA with plaque rupture and erosion and middle lesion with plaque rupture,thrombus,易损斑块破裂MSCT与OCT比较,患者，男性，73岁，不稳定心绞痛,OCT 结果,心肌梗死与富含脂质斑块、薄纤维帽、斑块破裂,OCT与新生血管,A 68-year-old man with persistent chest pain for 7 hours,diagnosed with high lateral and lateral wall myocardial infarction,and successfully reperfused by intravenous r-PA thrombolysis.Selective angiography revealed a 95%stenosis of LCX.OCT was acquired at the culprit lesion in the LCX before PCI.,应用OCT评价急性冠脉综合征的临床资料,OCT与AMI,ACS和SAP,(Jang IK，et al.Circulation，2005，111：1551-1555）,AMI患者OCT，CAS和IVUS图像比较（n=30）,TCFA:Thin cap fibroatheroma;LRP:Lipid rich plaque,(Kubo T,et al.JACC,2007,50:933-939),血管正性重构与OCT所见,Raffel OC,et al.Eur Heart J,2008,29:1721-1728,OCT 与UAP和SAP,Chen BX,et al.Chin J Cardiol,2009,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。,THANKS,
