IVUS血管内超声基础和临床课件.ppt

1、The CardiovascularResearch FoundationLenox Hill Heart and VascularInstitute of New York文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。IVUS 培训 The CardiovascularResearch FoundationLenox Hill Heart and VascularInstitute of New York文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。血管内超声基础和进展血管内超声基础和进展一、一、血管内超声基础二、血管内超声和冠

2、脉造影的关系二、血管内超声和冠脉造影的关系三、主要适应症三、主要适应症四、什么是四、什么是VHIVUS 培训 The CardiovascularResearch FoundationLenox Hill Heart and VascularInstitute of New York文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Rotating ElementDrive ShaftMulti-element ArrayThe CardiovascularResearch FoundationLenox Hill Heart and VascularInstitu

3、te of New YorkThere are two types of imaging systems:Mechanical(rotating transducer)and Electronic ArrayIVUS 培训 The CardiovascularResearch FoundationLenox Hill Heart and VascularInstitute of New York文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。The CardiovascularResearch FoundationLenox Hill Heart and Vasc

4、ularInstitute of New YorkIVUS 培训 The CardiovascularResearch FoundationLenox Hill Heart and VascularInstitute of New York文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。ALThe CardiovascularResearch FoundationLenox Hill Heart and VascularInstitute of New YorkIVUS 培训 The CardiovascularResearch FoundationLenox H

5、ill Heart and VascularInstitute of New York文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Low dynamic rangeHigh dynamic rangeThe CardiovascularResearch FoundationLenox Hill Heart and VascularInstitute of New YorkIVUS 培训 The CardiovascularResearch FoundationLenox Hill Heart and VascularInstitute of New York文

6、档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Intimal disease(plaque)is dense and will appear whiteMedia is made of homogeneous smooth muscle cells and does not reflect ultrasound(appears dark)Adventitia has sheets of collagen that reflect a lot of ultrasound(appears white)The CardiovascularResearch Foundat

7、ionLenox Hill Heart and VascularInstitute of New YorkIVUS 培训 The CardiovascularResearch FoundationLenox Hill Heart and VascularInstitute of New York文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。The CardiovascularResearch FoundationLenox Hill Heart and VascularInstitute of New YorkIVUS 培训 The Cardiovascular

8、Research FoundationLenox Hill Heart and VascularInstitute of New York文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。CalciumBright echoes(brighter than the adventitia)Obstructs the penetration of ultrasound(acoustic shadowing)only the leading edge is detected and thickness cannot be determined.Results in rev

9、erberations-the oscillation of ultrasound between transducer and calcium causing repeating arcsIVUS 培训 The CardiovascularResearch FoundationLenox Hill Heart and VascularInstitute of New York文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。The CardiovascularResearch FoundationLenox Hill Heart and VascularInsti

10、tute of New YorkIVUS 培训 The CardiovascularResearch FoundationLenox Hill Heart and VascularInstitute of New York文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Fibrotic PlaqueAs bright or brighter than the adventitia(hyperechoic)Majority of atherosclerotic lesions are fibroticVery dense,fibrous plaques may ca

11、use so much acoustic shadowing that they could be misclassified as calcifiedIVUS 培训 The CardiovascularResearch FoundationLenox Hill Heart and VascularInstitute of New York文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Soft PlaqueNot as bright as the adventitia(hypoechoic)“Soft”refers to the low echogenicity

12、,generally due to high lipid content in a mostly cellular lesion.Reduced echodensity may also be due to:necrotic zone within plaqueintramural hemorrhagethrombusIVUS 培训 The CardiovascularResearch FoundationLenox Hill Heart and VascularInstitute of New York文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Vulner

13、able PlaqueIVUS 培训 The CardiovascularResearch FoundationLenox Hill Heart and VascularInstitute of New York文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Mixed PlaqueIVUS 培训 The CardiovascularResearch FoundationLenox Hill Heart and VascularInstitute of New York文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Example o

14、f ThrombusIVUS 培训 The CardiovascularResearch FoundationLenox Hill Heart and VascularInstitute of New York文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Examples of ThrombusIVUS 培训 The CardiovascularResearch FoundationLenox Hill Heart and VascularInstitute of New York文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Ba

15、sic Measurements(I)External elastic membrane(EEM)cross sectional area(CSA)=total arterial CSA =media areatracing the boundary between the dark media and thebright adventitia(i.e.,the apparent outer edge of the media stripe)Lumen CSAMax and min lumen diametersStent CSA Max and min stent diametersPlaq

16、ue+media(P+M)CSA=EEM-Lumen CSA in non-stented lesions=EEM-stent CSA in stented lesionsIntimal hyperplasia CSA=Stent-Lumen CSAIVUS 培训 The CardiovascularResearch FoundationLenox Hill Heart and VascularInstitute of New York文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Basic Measurements(II)Eccentricity=maximu

17、m/minimum P+M thicknessPlaque Burden(=cross-sectional narrowing or%plaque area)=P+M/EEM CSARemodeling Index=Lesion/Reference EEM CSAArea Stenosis=(Reference-Lesion)/Reference Lumen CSAArc of calciumLesion lengths measured using motorized transducer pullback,ideally at 0.5 mm/secIVUS 培训 The Cardiovas

18、cularResearch FoundationLenox Hill Heart and VascularInstitute of New York文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Non-stented arteryEEMGuidewiresIVUS catheterPlaque+mediaLumenIVUS 培训 The CardiovascularResearch FoundationLenox Hill Heart and VascularInstitute of New York文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系

19、网站或本人删除。Stented ArteryEEMLumenStentGuidewireIVUS catheterPlaque+mediaIntimal hyperplasiaIVUS 培训 The CardiovascularResearch FoundationLenox Hill Heart and VascularInstitute of New York文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。The CardiovascularResearch FoundationLenox Hill Heart and VascularInstitute of

20、 New YorkIVUS 培训 The CardiovascularResearch FoundationLenox Hill Heart and VascularInstitute of New York文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。The CardiovascularResearch FoundationLenox Hill Heart and VascularInstitute of New YorkIVUS 培训 The CardiovascularResearch FoundationLenox Hill Heart and Vasc

21、ularInstitute of New York文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。In-Stent RestenosisIVUS 培训 The CardiovascularResearch FoundationLenox Hill Heart and VascularInstitute of New York文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。血管内超声基础和进展血管内超声基础和进展一、血管内超声基础一、血管内超声基础二、二、血管内超声和冠脉造影的关系三、主要适应症三、主要适应症四、什么是四、什么是VHIV

22、US 培训 The CardiovascularResearch FoundationLenox Hill Heart and VascularInstitute of New York文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Limitations of Coronary AngiographyFocal Disease50%Lesion50%LesionDiffuse DiseaseAngiogram SilhouetteIVUS 培训 The CardiovascularResearch FoundationLenox Hill Heart and V

23、ascularInstitute of New York文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Angiographically Silent DiseaseIVUS 培训 The CardiovascularResearch FoundationLenox Hill Heart and VascularInstitute of New York文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Coronary Remodeling HypothesisCompenatory ExpansionMaintains Consist

24、ant LumenExpansionOvercome:Lumen NarrowsNormal VesselMinimal CADModerate CADSevere CADIVUS 培训 The CardiovascularResearch FoundationLenox Hill Heart and VascularInstitute of New York文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Dicotomous Classification of RemodelingIVUS 培训 The CardiovascularResearch Founda

25、tionLenox Hill Heart and VascularInstitute of New York文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。ABDEffCFdistalLumenebebLumenccdistalIVUS 培训 The CardiovascularResearch FoundationLenox Hill Heart and VascularInstitute of New York文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Limitations of Coronary AngiographyAn

26、giogram SilhouetteCoronary Cross-section75%25%IVUS 培训 The CardiovascularResearch FoundationLenox Hill Heart and VascularInstitute of New York文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Irregular Plaque/Irregular LumenACross-sectionRAO ViewLAO ViewBCIVUS 培训 The CardiovascularResearch FoundationLenox Hill

27、Heart and VascularInstitute of New York文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。The CardiovascularResearch FoundationLenox Hill Heart and VascularInstitute of New YorkIVUSEEM CSA=22.7mm2Lumen CSA=16.6mm2Mean lumen diameter=4.6mmQCA9F guiding catheterReference diameter=3.12mmIVUS 培训 The CardiovascularR

28、esearch FoundationLenox Hill Heart and VascularInstitute of New York文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。血管内超声基础和进展血管内超声基础和进展一、血管内超声基础一、血管内超声基础二、血管内超声和冠脉造影的关系二、血管内超声和冠脉造影的关系三、三、主要适应症四、什么是四、什么是VHIVUS 培训 The CardiovascularResearch FoundationLenox Hill Heart and VascularInstitute of New York文档仅供参考，不能

29、作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。IVUS 培训 (Fisher et al.CCD 1982;8:565-575)QC labClinical site10001000Of all the coronary segments,the LM is the one with the greatest inter-observer variability Poor interobserver agreement in the angiographic assessment of LMCA stenosis in the CASS study-IThe Cardiovasc

30、ularResearch FoundationLenox Hill Heart and VascularInstitute of New York文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Poor interobserver agreement in the angiographic assessment of LMCA stenosis in the CASS study-II(Cameron et al.Circulation 1983;68:484-489)020406080100-3-2-10+1+2+3+4Five grades of LM sev

31、erity1:0-24%DS2:25-49%DS3:50-74%DS4:75-89%DS5:90-100%DS#of grades of difference in assessment of LM severity 0:no difference+1 or-1:1 grade difference+2 or-2:2 grades of difference+3 or-3:3 grades of difference+4 or-4:4 grades of difference020406080100-3-2-10+1+2+3+4020406080100-2-10+1+2IVUS 培训 The

32、CardiovascularResearch FoundationLenox Hill Heart and VascularInstitute of New York文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。IVUS 培训 ReferenceLesion10 mmThe CardiovascularResearch FoundationLenox Hill Heart and VascularInstitute of New York文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Suggested IVUS Criteria

33、for a Significant LMCA StenosisMost IVUS LMCA studies show either insignificant disease or critical disease,only a minority require careful quantificationLumen CSA 6.0mm2 or MLD 3.0mm are suggested criteria for a significant LMCA stenosisThe sum of the lumen areas of the two daughter vessels(LAD and

34、 LCX,each of which should be 4.0mm2)=150%of the parent(LM)These correlated with an abnormal FFR(Jasti et al Circulation 2004;110:2831-6)IVUS 培训 The CardiovascularResearch FoundationLenox Hill Heart and VascularInstitute of New York文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。IVUS 培训 Unusual Lesions:IVUS C

35、lassification of Angiographic AneurysmsOf 77 angiographic aneurysms 21(27%)true aneurysm3(4%)pseudoaneurysm12(16%)complex plaques or unhealed dissections41(53%)normal segment adjacent to one or more stenosesTrueAneurysmPSAComplexPlaqueNormal Site withAdjacent StenosesNo prior PCI100626Prior PCI11361

36、5The CardiovascularResearch FoundationLenox Hill Heart and VascularInstitute of New York文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。018mmThe CardiovascularResearch FoundationLenox Hill Heart and VascularInstitute of New York文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。The CardiovascularResearch FoundationLenox

37、 Hill Heart and VascularInstitute of New York文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。The CardiovascularResearch FoundationLenox Hill Heart and VascularInstitute of New York文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。The CardiovascularResearch FoundationLenox Hill Heart and VascularInstitute of New York文档仅

38、供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。The CardiovascularResearch FoundationLenox Hill Heart and VascularInstitute of New York文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。The high predictive value(90%)for the minimum stent CSA in Cypher stents suggests that most causes of Cypher stent failure will be“mechani

39、cal”(Sonoda et al.J Am Coll Cardiol 2004;43:1959-63)The CardiovascularResearch FoundationLenox Hill Heart and VascularInstitute of New York文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Predictors of angiographic restenosis in 550 pts with 670 native artery lesions treated with Cypher stents40mm17.7%8.6%The

40、 CardiovascularResearch FoundationLenox Hill Heart and VascularInstitute of New York文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。0246810121402468101214IVUS Measured MSA(mm2)Predicted MSA(mm2)012345012345IVUS Measured MSD(mm)Predicted MSD(mm)The CardiovascularResearch FoundationLenox Hill Heart and Vascula

41、rInstitute of New York文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Peri-Stent Haziness:Double LumenThe CardiovascularResearch FoundationLenox Hill Heart and VascularInstitute of New York文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Peri-Stent Haziness:Plaque BurdenTwoOverlappingStentsHazySegmentThe Cardiovascula

42、rResearch FoundationLenox Hill Heart and VascularInstitute of New York文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Peri-Stent Haziness:CalcificationStentThe CardiovascularResearch FoundationLenox Hill Heart and VascularInstitute of New York文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Peri-Stent Injury:Plaque Te

43、arUltrasoundSiteStentThe CardiovascularResearch FoundationLenox Hill Heart and VascularInstitute of New York文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。何时采用何时采用IVUS IVUS 以达到最佳的以达到最佳的 DES DES 置入置入高危患者亚组高危患者亚组肾功能不全肾功能不全SATSAT双重抗血小板药物使用的局限性双重抗血小板药物使用的局限性SATSAT糖尿病糖尿病ISR,SATISR,SAT左心室功能差左心室功能差SATSAT高危病变亚组高危病变

44、亚组分叉病变分叉病变ISR,SATISR,SAT开口病变开口病变ISRISR小血管小血管ISRISR长病变长病变ISRISR治疗支架内再狭窄（治疗支架内再狭窄（ISRISR）ISRISR左主干病变左主干病变 (特别是具有上述矛盾的结果和危险因素特别是具有上述矛盾的结果和危险因素)The CardiovascularResearch FoundationLenox Hill Heart and VascularInstitute of New York文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。血管内超声基础和进展血管内超声基础和进展一、血管内超声基础一、血管内

45、超声基础二、血管内超声和冠脉造影的关系二、血管内超声和冠脉造影的关系三、主要适应症三、主要适应症四、四、什么是VHIVUS 培训 The CardiovascularResearch FoundationLenox Hill Heart and VascularInstitute of New York文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Virtual HistologyTM VolcanoIVUS 培训 The CardiovascularResearch FoundationLenox Hill Heart and VascularInstitut

46、e of New York文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Virtual HistologyTM VolcanoFIBROTICFIBRO-LIPIDCALCIFICLIPID COREMEDIALegendMa xP -2 5.05Typ e:C olla ge n#of RO Is:2 6Int -28.65#of RO Is:3 1Int -14.8Typ e:C olla ge n#of RO Is:5F at Ma xP 21.04 5Typ e:C olla ge n#of RO Is:1 7MB F -6 5.0 9#of RO Is

47、:2 7Int -4.1 95Typ e:C olla ge n#of RO Is:5MB F -6 5.0 9#of RO Is:1 1F at Ma xP 30.03#of RO Is:3 8Ma xP -1 6.09 5Typ e:C olla ge n#of RO Is:6F at Ma xP 34.27 5Typ e:N ecr otic#of RO Is:6MB F -6 6.6 5Typ e:C olla ge n#of RO Is:5Ma xP -1 2.14 5Typ e:Fib ro-Lipidic#of RO Is:5F at Ma xP 34.27 5#of RO Is

48、:1 5Ma xP -9.9 15#of RO Is:2 1F at Ma xP 35.5Typ e:C olla ge n#of RO Is:9Ma xP -9.9 15#of RO Is:1 7Ma xP -1 6.09 5#of RO Is:3 8F at Ma xP 30.03#of RO Is:4 4Int -28.65#of RO Is:8 2MB F -5 5.6 95#of RO Is:1 13MinP -1 7.9 15Typ e:C olla ge n#of RO Is:5MB F -5 3.1 5Typ e:C alciu m#of RO Is:2 0MinP -1 7.

49、9 15#of RO Is:2 8MB F -5 5.6 95#of RO Is:3 31 46#of RO Is:TREEROOTIVUS 培训 The CardiovascularResearch FoundationLenox Hill Heart and VascularInstitute of New York文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Comparison Between VH and Histology020406080100PredictiveAccuracySensitivitySpecificityFibrousFibro-

50、fattyDense calciumNecrotic coreIVUS 培训 The CardiovascularResearch FoundationLenox Hill Heart and VascularInstitute of New York文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Virtual HistologyTMIVUS 培训 The CardiovascularResearch FoundationLenox Hill Heart and VascularInstitute of New York文档仅供参考，不能作为科学依据，请勿模仿；