Abstract
Nel corso di questi ultimi anni lo sviluppo delle tecniche di imaging coronarico ha ridefinito i limiti e l’utilità dell’angiografia coronarica, ancor oggi considerata la tecnica di imaging più accurata per la valutazione della cardiopatia ischemica. Tuttavia la visualizzazione della maggior parte delle placche responsabili di un evento coronarico acuto non è evidenziabile da questa tecnica. La presenza di queste limitazioni ha favorito lo sviluppo di sistemi di imaging integrato in sala di emodinamica quali l’IVUS (Intravascular Ultrasound) e l’OCT (Optical Choerence Thomography).
L’IVUS fornisce un’immagine diretta e in tempo reale dell’ateroma, garantendo una prospettiva tomografica delle coronarie e della placca aterosclerotica; inoltre con la virtual histology le varie componenti tissutali vengono codificate in mappe di colori, fornendo un surrogato dell’istologia nello studio dell’aterosclerosi in vivo.
L’OCT è una tecnologia di imaging ad alta risoluzione che utilizza una sorgente di luce che permette accurate misurazioni delle aree, dei diametri luminali, e una minuziosa caratterizzazione della placca con la possibilità di misurarne lo spessore della capsula fibrosa che la delimita.
Quindi le nuove metodiche di imaging coronarico hanno affiancato la tradizionale angiografia coronarica e segnato un punto di svolta nell’interpretazione della malattia coronarica.
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Letture consigliate
American College of Cardiology (2001) Clinical Expert Consensus Document on Standards for Acquisition, Measurement and Reporting of Intravascular Ultrasound Studies (IVUS). JACC 37:1478–1492
Bezerra HG, Costa MA, Guagliumi G et al (2009) Intracoronary optical coherence tomography: a comprehensive review clinical and research applications. JACC Cardiovasc Interv 11:1035–1046
BE, Tearney GJ, Yabushita H et al (2003) Evaluation of intra-coronary stenting by intravascular optical coherence tomography. Heart 89:317–321
Burke AP, Farb A, Malcom GT et al (1997) Coronary risk factors and plaque morphology in men with coronary disease who died suddenly. N Engl J Med 336:1276–1282
Capodanno D, Prati F, Pawlowsky T et al (2009) Comparison of optical coherence tomography and intravascular ultrasound for the assessment of in-stent tissue coverage after stent implantation. Euro Intervention 5:538–543
De Bruyne B, Bartunek J, Sys SU et al (1996) Simultaneous coronary pressure and flow velocity mesaurement in humans. Feasibility, reproducibility and hemodynamic dependance of coronary flow velocity reserve, hyperemic flow verus pressure sloop index and fractional flow reserve. Circulation 94:1842–1849
Di Mario C, Görge G, Peters R et al (1998) Clinical application and im-age interpretation in intracoronary ultrasound. Study Group on Intracoronary Imaging of the Working Group of Coronary Circulation and of the Subgroup on Intravascular Ultrasound of the Working Group of Echocar-diography of the European Society of Cardiology. Eur Heart J 19:207–229
Falk E, Shah PK, Fuster V (1995) Coronary plaque disruption. Circulation 92:657–671
Glagov S, Weisenberg E, Zarins CK et al (1987) Compensatory enlarge-ment of human atherosclerotic coronary arteries. N Engl J Med 316:1371–1375
Gould KL, Kirkeeide RL, Buchi M (1990) Coronary flow reserve as a physiologic measure of stenosis severity. J Am Coll Cardiol 15:459–474
Gussenhoven EJ, Essed CE, Frietman P et al (1989) Intravascular ultra-sonic imaging: histologic and echographic correlation. Eur J Vasc Surg 3:571–576
Gussenhoven EJ, Essed CE, Lancée CT et al (1989) Arterial wall charac-teristics determined by intravascular ultrasound imaging: an in vitro study. J Am Coll Cardiol 14:947–952
Kemp HG, Kronmal RA, Vlietstra RE, Frye RL (1986) Seven year sur-vival of patients with normal or near normal coronary arteriograms: a CASS registry study. J Am Coll Cardiol 7:479–483
Kubo T, Maehara A, Mintz GS et al (2010) The dynamic nature of coro-nary artery lesion morphology assessed by serial virtual histology in-travascular ultrasound tissue characterization. J Am Coll Cardiol 55:1590–1597
Nissen SE, Yock P (2001) Intravascular ultrasound: novel pathophysi-ological insights and current clinical applications. Circulation 103:604–616
Patel MR, Peterson ED, Dai D et al (2010) Low diagnostic yield of elec-tive coronary angiography. N Engl J Med 362:886–895
Popma JJ. (2001)Coronary angiography and intravascular ultrasound imaging. In: Zipes DP, Libby P, Bonow RO, Braunwald E (eds) Braunwald’s Heart disease, pp. 425–455. Philadelphia, Elsevier Saunders
Potkin BN, Bartorelli AL, Gessert JM et al (1990) Coronary artery ima-ging with intravascular high-frequency ultrasound. Circulation 81:1575–1585
Prati F, Regar E, Mintz GS et al (2010) Expert review document on methodology, terminology, and clinical applications of optical coherence tomography: physical principles, methodology of image acquisition, and clinical application for assessment of coronary arteries and atherosclero-sis. Eur Heart J 31:401–415
Schaar JA, Muller JE, Falk E et al (2004) Terminology for high-risk and vulnerable coronary artery plaques. Report of a meeting on the vulnerable plaque. Eur Heart J 25:1077–1082
Tearney GJ, Waxman S, Shishkov M et al (2008) Three-dimensional coronary artery microscopy by intracoronary optical frequency domain imaging. J Am Coll Cardiol Img 1:752–761
Tonino PAL, Fearon WF, De Bruyne B et al (2010) Angiographic versus functional severity of coronary artery stenoses in the FAME Study: Fractional flow reserve versus angiography in multivessel evaluation. J Am Coll Cardiol 55:2816–2821
Topol EJ, Nissen SE (1995) Our preoccupation with coronary luminology. The dissociation between clinical and angiographic findings in ischemic heart disease. Circulation 92:2333–2342
Yabushita H, Bouma BE, Houser SL et al (2002) Characterization of human atherosclerosis by optical coherence tomography. Circulation 106:1640–1645
Yamaguchi T, Terashima M, Akasaka T et al (2008) Safety and feasibility of an intravascular optical coherence tomography image wire system in the clinical setting. Am J Cardiol 101:562–567
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Fioranelli, M., D’Angeli, I., Pironi, B. (2011). Imaging integrato. In: Cardiologia dello Sport. Springer, Milano. https://doi.org/10.1007/978-88-470-2352-9_11
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