New imaging methods of coronary arteries

Abstract

Coronary angiography is still the most widely used method for assessment of lumen of coronary arteries and for diagnostics and treatment of coronary artery disease. New imaging modalities of coronary arteries play increasing role in interventional cardiology. Intravascular ultrasound (IVUS) is the oldest technology. Due to high tissue penetration it is very important for imaging of left main coronary artery and saphenous vein grafts. IVUS was used in many clinical trials and clinical experience with it is huge. Optical coherence tomography (OCT) is a new, very fast developing method. It has ten times higher axial resolution than IVUS. It gives us the opportunity to assess the inner structures of coronary artery wall, to evaluate the characteristics of atherosclerotic plaques, quality of stent implantation and its healing. It helps us to find the culprit lesion of acute coronary syndrome in some cases, to diagnose the cause of stent thrombosis, to evaluate stent apposition which has a direct relation to prognosis. We use it for performing of complex percutaneous coronary interventions and after heart transplantation to diagnose the vascular graft disease. We strongly believe that OCT is important for assessment of plaque instability and patient´s prognosis. Near infrared spectroscopy combined with IVUS can distinguish fibrous from lipid core plaques. Lipid core burden index is in relation to a risk of periprocedural myocardial infarction and to prognosis. It is the only method which can sufficiently detect the amount of lipids in coronary wall.