Semptom Pozitif Ara Lezyonu Olan Hastaya Yaklaşım
Özet
Koroner arter hastalığı (KAH), Dünya genelinde morbidite ve mortalitenin önde gelen nedenlerinden biridir. Aterogenez, dünya genelinde kardiyovasküler hastalıkların morbidite ve mortalitesinin başlıca nedenlerinden biridir. Koroner anjiyografi, uzun yıllardır darlıkların anatomik değerlendirilmesinde altın standart olarak kabul edilse de bir lezyonun fizyolojik anlamda ne kadar önemli olduğunu belirlemede, plakların yapılarının değerlendirilmesinde yetersiz kalabilir ve değerlendirilen koroner lezyonların anatomik darlık derecesi, her zaman miyokardiyal iskeminin varlığını öngöremez. Bu bağlamda Fraksiyonel Akış Rezervi (FFR) lezyonun fonksiyonel açıdan değerlendirilmesinde, Intravasküler Ultrason (IVUS) plakların ve Optik Koherens Tomografi (OCT) ise vasküler yapı ve plağın morfolojik olarak değerlendirilmesinde önemli bilgiler sunar. Sonuç olarak bu yöntemler lezyonların perkütan koroner girişim gerektirip gerektirmediği kararı aşamasında anjiyografiye tamamlayıcı önemli değerlendirme araçları olarak karşımıza çıkıyorlar. Bu bölümde yardımcı görüntüleme araçlarından yararlanarak avantaj ve dezavantajlarını da göz önünde bulundurarak hasta bazlı bireyselleştirilmiş değerlendirmeyle semptomatik olan fakat FFR, IVUS, OCT nonkritik olarak değerlendirilen hastalara yaklaşımdan bahsedeceğiz.
Referanslar
Neumann FJ, Sousa-Uva M, Ahlsson A, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J 2019;40:87 165. doi:10.1093/eurheartj/ehy394
Hill D, Bykowski A, Lim MJ, et al. Fractional Flow Reserve. In: StatPearls [İnternet]. Treasure Island (FL): StatPearls Publishing; 12 Eylül 2022 [erişim tarihi: 12 Eylül 2022]. Erişim adresi: https://www.ncbi.nlm.nih.gov/books/NBK482324/
Yıldırır, A. (2011). Girişimsel Kardiyoloji / Fraksiyonel akım yedeği (FFR) ölçümüne ilişkin pratik ipuçları. Turk Kardiyol Dern Ars, 39(5), 433-435.
Adjedj J, De Bruyne B, Floré V, et al. Significance of intermediate values of fractional flow reserve in patients with coronary artery disease. Circulation 2016;133:502 508. doi:10.1161/CIRCULATIONAHA.115.018747
Tonino P. A. L., De Bruyne B., Pijls N. H. J., et al. Fractional Flow Reserve versus Angiography for Guiding Percutaneous Coronary Intervention. N Engl J Med. 2009;360(3):213 224. DOI: 10.1056/NEJMoa0807611
De Bruyne B, Pijls NHJ, Kalesan B, et al. Fractional Flow Reserve Guided PCI versus Medical Therapy in Stable Coronary Disease. N Engl J Med. 2012;367(11):991 1001. DOI:10.1056/NEJMoa1205361
van Nunen LX, Zimmermann FM, Tonino PAL, et al. Fractional flow reserve versus angiography for guidance of PCI in patients with multivessel coronary artery disease (FAME): 5 year follow up of a randomised controlled trial. Lancet. 2015;386(10006):1853 1860. doi:10.1016/S0140 6736(15)00057 4
Pijls, N. H., Fearon, W. F., Tonino, P. A., et al. (2010). Fractional flow reserve versus angiography for guiding percutaneous coronary intervention in patients with multivessel coronary artery disease: 2 year follow up of the FAME (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation) Study. Journal of the American College of Cardiology, 56(3), 177 184. DOI:10.1016/j.jacc.2010.04.012
Lee J, Jung J, Hwang D ve ark. Coronary Flow Reserve and Microcirculatory Resistance in Patients With Intermediate Coronary Stenosis. J Am Coll Cardiol. 2016;67(10):1158-1169. doi:10.1016/j.jacc.2015.12.053
Kelshiker MA, Seligman H, Howard JP, et al. Coronary flow reserve and cardiovascular outcomes: a systematic review and meta-analysis. Eur Heart J. 2022;43(16):1582-1593. doi:10.1093/eurheartj/ehab775
Fearon WF, Balsam LB, Farouque HM, et al. Novel index for invasively assessing the coronary microcirculation. Circulation. 2003;107(25):3129–3132. doi:10.1161/01.CIR.0000080700.98607.D1.
Virani SS, Newby LK, Arnold SV, et al. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation. 2023;148(9):e9 e119. doi:10.1161/CIR.0000000000001168
Mintz GS, Nissen SE, Anderson WD, et al. American College of Cardiology Clinical Expert Consensus Document on Standards for Acquisition, Measurement and Reporting of Intravascular Ultrasound Studies (IVUS). A report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol. 2001;37(5):1478–1492. doi:10.1016/s0735-1097(01)01175-5
ERMİŞ C, KILIÇKAP M, TUZCU EM. Koroner Ateroskleroz Tanısında Damariçi Ultrason. Turk Kardiyol Dern Ars. 2002 Nisan;30(4):254-264.
Schoenhagen P, Nissen S. Understanding coronary artery disease: tomographic imaging with intravascular ultrasound. Heart. 2002;88(1):91-96. doi:10.1136/heart.88.1.91
McDaniel MC, Eshtehardi P, Sawaya FJ, et al. Contemporary Clinical Applications of Coronary Intravascular Ultrasound. JACC Cardiovasc Interv. 2011;4(11):1155–1167. doi:10.1016/j.jcin.2011.07.013
Nissen SE, Yock P, et al. Intravascular ultrasound: novel pathophysiological insights and current clinical applications. Circulation. 2001;103(4):604 616. doi:10.1161/01.CIR.103.4.604
Ge J, Liu F, Görge G, et al. Angiographically ‘silent’ plaque in the left main coronary artery detected by intravascular ultrasound. Coron Artery Dis. 1995;6(10):805 810. doi:10.1097/00019501 199510000 00008
Mariani J Jr, Guedes C, Soares P, et al. Intravascular Ultrasound Guidance to Minimize the Use of Iodine Contrast in Percutaneous Coronary Intervention: The MOZART (Minimizing contrast utiliZation With IVUS Guidance in coronary angioplasty) Randomized Controlled Trial. JACC Cardiovasc Interv. 2014;7(11):1287 1293. doi:10.1016/j.jcin.2014.05.024
Velarde Acosta K, Moscoso Ramirez JY, Rojas P, et al. Acute left anterior descending artery occlusion after IVUS leading to urgent percutaneous coronary intervention complicated with coronary perforation: Case report. JRSM Cardiovasc Dis. 2024;13:20480040241248924. doi:10.1177/20480040241248924
Gülel O, Sipahi I, Tuzcu EM, et al. Intravascular ultrasound: questions and answers. Anatol J Cardiol. 2007;7(2):169 178. doi:10.5152/AnatolJCardiol.2007.169
Baruś P, Modrzewski J, Gumiężna K, et al. Comparative Appraisal of Intravascular Ultrasound and Optical Coherence Tomography in Invasive Coronary Imaging: 2022 Update. J Clin Med. 2022;11(14):4055. doi:10.3390/jcm11144055
Mintz GS, Lefèvre T, Lassen JF, et al. Intravascular ultrasound in the evaluation and treatment of left main coronary artery disease: A consensus statement from the European Bifurcation Club. EuroIntervention. 2018;14(4):e467-e474. doi:10.4244/EIJ-D-18-00194
Bezerra H, Costa M, Guagliumi G, et al. Intracoronary optical coherence tomography: a comprehensive review: clinical and research applications. J Am Coll Cardiol Intv. 2009;2(11):1035–1046
Subban V, Raffel OC. Optical coherence tomography: fundamentals and clinical utility. Cardiovasc Diagn Ther. 2020;10(5):1389-1414. doi:10.21037/cdt-20-253.
Ali Z, Galougahi K, Mintz G, et al. Intracoronary optical coherence tomography: state of the art and future directions. EuroIntervention. 2021;17(2):E105 E123
Roleder T, Jąkała J, Kałuża GL, et al. The basics of intravascular optical coherence tomography. Postepy Kardiol Interwencyjnej. 2015;11(2):74-83. doi:10.5114/pwki.2015.52278.
Xing L, Higuma T, Wang Z, et al. Clinical significance of lipid-rich plaque detected by optical coherence tomography: a 4-year follow-up study. J Am Coll Cardiol. 2017;69(20):2502-2513. doi:10.1016/j.jacc.2017.03.556
Schukraft S, Arroyo D, Togni M, et al. Five-year angiographic, OCT and clinical outcomes of a randomized comparison of everolimus and biolimus-eluting coronary stents with everolimus-eluting bioresorbable vascular scaffolds. Catheter Cardiovasc Interv. 2022;99(3):523-532. doi:10.1002/ccd.29837
