Release date: 2009-02-06




At present, there are more than 40 million patients with coronary heart disease in China. It is not difficult to imagine that the high incidence of coronary heart disease has brought great opportunities for the development of diagnostic equipment. In recent years, clinical diagnostic equipment and techniques for coronary heart disease have emerged in an endless stream, including non-invasive systems such as echocardiography, multi-slice spiral computed tomography (MSCT), high-resolution nuclear magnetic resonance imaging (MRI) and nuclear imaging. Coronary angiography (CAG), intracoronary ultrasound (IVUS), optical coherence tomography (OCT), virtual tissue imaging (VH), elastic force map, temperature map (thermal image method for plaque temperature), near infrared Invasive systems and techniques such as spectroscopy, Raman spectroscopy, intravascular MRI, and intracoronary angioscopy. So which of these methods has the most potential for development? Clinical experts have the most say about this issue. Professor Lu Shuzhen, a professor of cardiology at Beijing Anzhen Hospital, recently told reporters that the focus of coronary heart disease research is the detection and discovery of vulnerable plaques, and the extremely high resolution of optical coherence tomography for coronary lesions is any other existing imaging. The technology is unmatched, so this technology has become the most "hot" new technology in the clinical community of coronary heart disease in China at home and abroad.

Extremely high resolution
In recent years, with the rapid development of coronary interventional therapy, emerging diagnostic systems have emerged as the times require. Among them, intravascular ultrasound systems and intracoronary vascularoscopy have attracted much attention. Intravascular ultrasonography of the coronary arteries not only has important reference value for judging the degree of coronary artery lesions, whether the plaque is stable, the size of the lumen, and whether intervention is needed, but also whether the stent is well adhered, the degree of lesion coverage, and the blood vessels after intervention. Whether the inner membrane is the main means of tearing is widely used worldwide. Intracoronary angioscopy can be used to evaluate the extent of stent coverage and thrombus in the endocardium. It is currently used in some hospitals in Japan. After the first report of the optical coherence tomography system in the world to obtain high-definition images in the human coronary artery in 2001, the application of this technology in the field of coronary heart disease intervention has gradually increased, and it has become one of the technologies that are highly concerned by experts at home and abroad.

Professor Lu Shuzheng said that optical coherence tomography is a new high-resolution tomographic imaging model that combines optical technology with ultra-sensitive detectors, using near-infrared light to probe microscale structures in blood vessels, and applying modern computer images. Processing, with extremely high resolution, can detect images below 65 to 70 microns, superior to any existing imaging technology. Foreign researchers Kubo T et al compared optical coherence tomography system, intracoronary ultrasound system and intracoronary angioscopy to evaluate the effect of lesions in patients with acute myocardial infarction. The results showed that the proportion of plaque rupture detected by the optical coherence tomography system was 73%, significantly higher than intracoronary endoscopic (47%) and intracoronary ultrasound (40%). And optical coherence tomography systems combined with backscattering techniques and attenuation coefficients provide better comparison of tissue characteristics. This technique has a good correlation with the histological structure under light and electron microscopy. This indicates that the system is expected to be an ideal means to evaluate the efficacy of unstable plaques and stents. Studies have also shown that the maximum diameter, area, stent wire and intimal thickness coverage of the same lesion observed by different observers using the optical coherence tomography system are consistent. This shows that the technology has good repeatability and accuracy.

Great application value
Professor Lu Shuzhen told reporters that it is worth noting that optical coherence tomography has changed the concept of re-endothelialization of the original stent to the concept of intimal tissue coverage. This technique can detect the thickness, area, distribution and thrombus formation of the covered tissue to determine the extent of coverage of the endometrial tissue within the stent. Compared with intravascular ultrasound, this technique is superior in judging the intimal tear, intimal tissue detachment, and stent malapposition caused by the stent. At present, some cardiac centers in the United States and Europe mainly use optical coherence tomography system to judge coronary instability plaques, especially the thickness of plaque fibrous caps and lipid nucleus; using this technique to determine endovascular tear and placement The degree of adherence of the stent after stenting, the coverage of the intima exposed in the lumen of the stent, and the relationship between the stent wire and the intima of the vessel; the system was also used to evaluate the degree of adherence of the stent in the acute phase after stent implantation. To determine the mechanism of the stent on the vessel wall, thrombosis in the stent, etc., to determine the perioperative vascular injury; several months to several years after stent implantation, the optical coherence tomography system was used to evaluate the mid-term and long-term postoperative stent placement. effect.

It is difficult to promote
Although clinical experts at home and abroad are very positive about the clinical application value of optical coherence tomography system, the cost of examinations for nearly 15,000 yuan (all at the expense of patients) makes many hospitals, related departments and patients in China only hope to sigh.

It is understood that at present, only five medical institutions in the People's Liberation Army General Hospital, Beijing Electric Power Hospital, Beijing Anzhen Hospital, the Second Affiliated Hospital of Harbin Medical University, and the Affiliated Hospital of the Armed Police Medical College have deployed optical coherence tomography systems. The number of cases has reached more than 100 cases. Beijing Anzhen Hospital purchased the fifth optical coherence tomography system in China in 2007. As of November 2008, the hospital has completed more than 30 inspections. (China Medical News)

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