[Optical coherence tomography imaging for the evaluation and treatment of calcified coronary artery disease].

IF 0.7 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Giornale italiano di cardiologia Pub Date : 2024-06-01 DOI:10.1714/4287.42688
Marco Busco, Alfredo Ricchiuto, Francesco Bianchini, Gianluca Anastasia, Fabio Pescetelli, Matteo Vercellino, Enrico Romagnoli, Francesco Burzotta, Carlo Trani, Italo Porto, Cristina Aurigemma, Rocco Vergallo
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Abstract

Coronary calcific disease represents one of the main challenges for the interventional cardiologist, for whom optimal lesion preparation and percutaneous coronary intervention optimization are paramount for correct management. In this perspective, intravascular imaging using optical coherence tomography (OCT) is becoming an increasingly indispensable tool. This work aims to provide a detailed overview of the complexity of calcified lesions, first analyzing their various morphologies and their clinical impact: spotty calcium seems to be more present in plaques at higher risk of destabilization, while diffuse calcification is typical of stable coronary stenosis; the eruptive calcific nodule is one of the three culprit lesion phenotypes responsible for acute coronary syndromes.In the second part of this review, the available technologies for the treatment of calcified lesions are described, with the aid of illustrative OCT images. Intravascular lithotripsy causes fractures at various levels of the calcified plaque, both circumferentially and longitudinally, with an improvement in vessel compliance; atherectomy acts by modifying the composition of the plaque with selective action on the hard calcific component. OCT, providing a comprehensive overview of lesion characteristics, can guide in the selection of the most appropriate therapeutic strategy, while also offering important information on the effectiveness of the chosen treatment.

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[用于评估和治疗钙化冠状动脉疾病的光学相干断层成像]。
冠状动脉钙化病是介入心脏病专家面临的主要挑战之一,对他们来说,最佳的病变准备和经皮冠状动脉介入治疗优化是正确治疗的关键。从这个角度来看,使用光学相干断层扫描(OCT)进行血管内成像正日益成为一种不可或缺的工具。本文旨在详细概述钙化病变的复杂性,首先分析钙化病变的各种形态及其临床影响:斑点状钙似乎更多出现在失稳风险较高的斑块中,而弥漫性钙化则是稳定型冠状动脉狭窄的典型表现;爆发性钙化结节是导致急性冠状动脉综合征的三种罪魁祸首病变表型之一。血管内碎石术可在钙化斑块的不同层面造成周向和纵向断裂,并改善血管顺应性;动脉粥样硬化切除术通过改变斑块的组成,选择性地作用于坚硬的钙化成分。OCT 能全面显示病变特征,为选择最合适的治疗策略提供指导,同时还能提供有关所选治疗方法有效性的重要信息。
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Giornale italiano di cardiologia
Giornale italiano di cardiologia CARDIAC & CARDIOVASCULAR SYSTEMS-
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