Zusammenfassung
Das akute Koronarsyndrom (ACS) wird entweder durch eine signifikante Verengung oder einen vollständigen Verschluss einer Koronararterie verursacht. Post-mortem-Studien konnten zeigen, dass kritische Stenosen bzw. der Verschluss einer Arterie bei Patienten mit ACS, die angiographische „culprit lesion“ (CL), vor allem aus frischem Thrombusmaterial bestehen; die Plaque-Ruptur – die eigentliche Ursache des Thrombenmaterials (wahre CL, „culprit of the CL“) – ist proximal oder distal der Läsion zu finden. Die Koronarangiographie reicht demzufolge als diagnostisches Werkzeug zur sicheren Identifikation und Untersuchung der wahren CL (Länge, Thrombusanteil, Durchmesser, Lokalisierung der Plaque-Ruptur, Identifikation von vulnerablen Plaque) nicht mehr aus. Der intravaskuläre Ultraschall (IVUS) erlaubt es einem interventionellen Kardiologen, die Gefäßwand und den atherosklerotischen Prozess in vivo zu sehen. Intravaskulärer „Virtual-histology“-Ultraschall stellt 4 Farben dar: hellgrün („fibrofatty tissue“), dunkelgrün („fibrotic tissue“), weiß („calcified tissue“) und rot („necrotic core“). Die optische Kohärenztomographie ist eine neue Art der intravaskulären Bildgebung; sie erlaubt, ähnlich wie der IVUS, jedoch präziser die In-vivo-Vermessung der Koronararterien (Durchmesser, Länge etc.) und die Bestimmung der CL (Thrombuslast, Plaque-Ruptur, Länge) sowie die Optimierung nach primärer perkutaner Koronarintervention (PPCI).
Abstract
Acute coronary syndrome (ACS) is caused by severe narrowing or total occlusion of the infarct-related artery (IRA). Post-mortem studies have shown that with angiography severe narrowing and occlusion (angiographic culprit lesion) in patients with ACS are mainly composed of fresh thrombi whereas the plaque rupture site, the actual culprit of the culprit lesion, which caused the ACS, can be located proximal or distal to the angiographic culprit lesion. Therefore, angiography is not sufficient for an accurate assessment of the true culprit lesion (e. g. length, thrombus burden, diameter, plaque rupture site and vulnerable plaques). Intravascular ultrasound (IVUS) allows the operator to study and assess the vessel wall in vivo. Virtual histology allows different types of tissue to be identified within the atherosclerotic plaque by means of four colors: light green (fibrofatty tissue), dark green (fibrotic tissue), white (calcified tissue) and red (necrotic tissue). Optical coherence tomography is a new imaging modality which allows the most accurate investigation of the coronary arteries (diameter and length) in vivo and the culprit lesions (thrombus burden, plaque rupture, length and vulnerable plaques) as well as optimization after primary percutaneous coronary interventions (PPCI).
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Einhaltung ethischer Richtlinien
Interessenkonflikt. B. Mrevlje, J. Legutko, F. Tillwich, J. Jakala, D. Dudek, M. Noč, L. Rzeszutko, P. Kleczynski, R. Birkemeyer, M. Aboukoura und C.A. Nienaber geben an, dass kein Interessenkonflikt besteht.
Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.
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Mrevlje, B., Legutko, J., Tillwich, F. et al. Intravaskuläre Bildgebung bei akutem Koronarsyndrom. Kardiologe 9, 47–53 (2015). https://doi.org/10.1007/s12181-014-0644-2
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DOI: https://doi.org/10.1007/s12181-014-0644-2
Schlüsselwörter
- Angiographische“culprit lesion”
- Plaque-Ruptur
- Virtuelle Histologie
- Intravaskulärer Ultraschall
- Optische Kohärenztomographie