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1、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
2、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
3、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 calcifica
4、tion,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 thic
5、kness(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 patien
6、t 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 persi
7、stent 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,A
8、CS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,
