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[EuroPCR 2011]临床血管内光学相干断层扫描图谱

作者:国际循环网   日期:2011/6/7 16:10:27

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当我们在2008年在Bern将光学相干断层扫描(OCT)作为导管室的应用介绍给大家的时候,关于OCT的原则和冠状动脉内应用的文章还很有限。而且这些文章没能为我们在导管室的患者获得OCT图像的解读提供有价值的信息。

  Tell us a little about the background and goal of this publication.
  Lorenz Raber (Bern, Switerland): When we introduced optical coherence tomography (OCT) as a cathlab application in Bern in 2008, there were only a handful of papers available about the principles and intracoronary use of OCT. These papers did not provide information that would be useful in the interpretation of OCT images that we obtained from our patients in the cathlab.
  Maria Radu (Copenhagen, Denmark.): Yes, I had exactly the same experience when I first became acquainted with OCT in Copenhagen a few years ago. Eager to learn about the interpretation of OCT images, I discovered that sources were very limited in terms of image interpretation in practice and how to recognise important pitfalls; I often felt alone with a lot of questions. Over the last few years, the number of OCT publications has increased significantly. However, published images are very often of varying quality and lack a systematic description. So apparently, we are still in the same situation. When I speak with both the more clinically oriented as well as research colleagues throughout our interventional community, there seems to be a clear need for an atlas of OCT that would provide guidance in the interpretation of images obtained with this wonderful technique.
  请介绍该刊物的一些背景和目标。
  Lorenz Raber (Bern, Zwiterland):当我们在2008年在Bern将光学相干断层扫描(OCT)作为导管室的应用介绍给大家的时候,关于OCT的原则和冠状动脉内应用的文章还很有限。而且这些文章没能为我们在导管室的患者获得OCT图像的解读提供有价值的信息。
  Maria Radu (Copenhagen, Denmark.):是的,当我在几年前初次在Copenhagen接触OCT时,有完全相同的经历。我非常想了解怎样判读OCT图像,但是发现关于实践中如何判读图像并发现重大错误的资源很有限。我常觉得有许多问题却无人解答。在过去的几年中,关于OCT的文章数量显著增加,然而图像的质量参差不齐并缺乏系统的描述。因此,我们显然仍处于同样的情况。当我与此方向上临床方面和科研方面的同事交流时,发现对OCT图谱有着明确的需求,以便为这项奇妙技术获得的图像的解读提供指导。
  What is special about this publication?
  Maria: At the moment, we find ourselves in Rotterdam and have the privilege to put together the most instructive OCT images gathered from our fellow colleagues’ and our own collections into a comprehensive atlas, under the guidance of Professor Patrick W. Serruys. But coming back to your question, the “Clinical Atlas of Intravascular OCT” has several unique features. To begin with, it is the first comprehensive atlas of OCTavailable, and is specifically designed to allow rapid access to knowledge in interpreting OCT images. The majority of images have been obtained during clinical work in the cathlab, thus representing the entire clinical spectrum that we encounter in our daily routine. To go with this, we have also collected the most frequently encountered artefacts and explain them in a dedicated chapter, which will allow the users to identify important pitfalls in OCT image interpretation. Beyond the most frequent findings related to coronary artery stenting, we have carefully selected “pearls” of clinical OCT, including findings in patients with ST-elevation myocardial infarction, rare findings at five years after DES implantation, and a sub-chapter about different mechanisms of very late stent thrombosis.
  Lorenz: We have additionally covered hot topics such as 3D OCT, and are fortunately in a unique position to present insights into bioresorbable vascular scaffolding. It is also important to realise that OCT has a few drawbacks, such as a limited tissue penetration which does not allow for visualisation of the entire vessel wall. It is against this background that we decided to complement the OCT findings of atherosclerosis with matched IVUS and IVUS-VH images because, naturally, corresponding histological images are rarely available in the clinic. In the chapter about atherosclerosis, we will present over 50 figures/pages illustrating different plaque types using OCT and corresponding IVUS, IVUS-VH, and in some cases also histology. Importantly, we can profit from our privileged situation here in Rotterdam, where we have the full support of experienced IVUS specialists such as Dr. Hector Garcia-Garcia, who is a co-editor of the “Clinical Atlas of Intravascular OCT”.
  Maria: I think we should not forget to mention that this “Clinical Atlas of Intravascular OCT” will be available as an iPad application, which allows the reader to explore OCT images in a unique way using different interactive features. So, if you already enjoy reading papers or books using the iPad, you will appreciate our decision to produce the atlas this way.
  这本书的特别之处在哪?
  Maria:目前,我们在Patrick W. Serruys 教授的指导下,在Rotterdam把来自同事们的和我们自己收集的最具启示性的OCT图像集合成一个综合性图谱。回到我们的问题上,“临床血管内OCT图谱”有些自己独一无二的特色。首先,它是目前唯一一本OCT综合性图谱,专门用来迅速获取解读OCT图像的知识。大部分图像来自导管室的临床工作,因此代表了我们日常工作中所能碰到的整个临床范围。另外,我们还收集了最常遇见的情况,并用专门一章解释,以便读者能判断OCT图像判读中最易犯的错误。除了这些与冠状动脉支架置入密切相关的发现外,我们还仔细筛选了临床OCT的“珍珠”,包括在ST段抬高心肌梗死患者上的发现,DES置入后5年的罕见发现,以及分章中介绍了极晚期支架血栓形成的不同机制。
  Lorenz:另外,我们还收录了3D OCT等热门主题,有幸在一个独特的角度为可吸收血管支架提出了见解。认识到OCT也有一些缺陷同样很重要,如有限的组织透过率,不能实现整个血管壁的可视化。这与我们想要用对应的IVUS和IVUS-VH图像补充动脉粥样硬化患者的OCT检查结果的初衷是抵触的,因为在临床上相应的组织学图像是很难获得的。在关于动脉粥样硬化这一章,我们采用OCT和相应IVUS、IVUS-VH,在某些病例中还采用了组织学,以超过50张图/页来说明不同的斑块类型。重要的是,我们在Rotterdam享受自己的特权,在这里,我们拥有IVUS专家Hector Garcia-Garcia的全力支持,他同时也是“临床血管内OCT图谱”的共同主编。
  Maria:我认为我们还应提及“临床血管内OCT图谱”支持iPad应用,这使得读者能够采用独特的互动方式来探索OCT图像。所以,如果您喜欢通过iPad阅读文章或书籍的话,将会对该图谱的这种制作方式非常欣赏。
  How difficult is it to work with the new media?
  Lorenz: In fact this is the first time that we have worked with this type of media. However, my impression is that it is far easier to create specifically for the iPad rather than to develop an e-book which then becomes available on the iPad. The choice of “going digital” also gives us the capability to enhance interactivity and regularly update, which will be key factors in making the “Clinical Atlas of Intravascular OCT” successful. We are happy that PCR publishing accepted to work with us on this project, which will certainly benefit from their experience with the iPad version of EuroIntervention.
  采用这种新型媒体的困难在哪里?
  Lorenz:这是我们第一次采用这种媒体。然而,我的印象是专门针对iPad设计远比制作一个支持iPad的网络书籍容易得多。采用数字化途径也使我们可以促进交流和定期更新,这是“临床血管内OCT图谱”成功的关键要素。我们很高兴PCR出版社在这个项目上同意与我们合作,从而在欧版iPad的这次经历中获益。


  选自《EuroPCR每日新闻》

版面编辑:赵书芳  责任编辑:聂会珍



Lorenz Räber Maria Radu血管内光学相干断层扫描

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