Skip to main content
Erschienen in: Die Kardiologie 2/2021

08.03.2021 | Angiografie | CME

Intravaskulärer Ultraschall bei der Beurteilung und Intervention von Hauptstammläsionen

verfasst von: Prof. Dr. med. Julian D. Widder

Erschienen in: Die Kardiologie | Ausgabe 2/2021

Einloggen, um Zugang zu erhalten

Zusammenfassung

Die exakte Beurteilung der Relevanz einer Hauptstammläsion mit der daraus folgenden Therapieentscheidung ist aufgrund ihrer prognostischen Bedeutung von hoher Relevanz, rein angiographisch aber oft nicht eindeutig möglich. Die perkutane Koronarintervention (PCI) ist heutzutage in vielen Fällen gegenüber der operativen Revaskularisierung eine gleichwertige Therapieoption bei signifikanter Hauptstammläsion. Ihre Durchführung ist komplex, und eine sorgfältige Läsionsvorbereitung, die richtige Auswahl der Stentstrategie sowie optimale Stentimplantation sind entscheidend für den Langzeiterfolg. Mit intravaskulärem Ultraschall (IVUS) kann die prognostische Relevanz einer angiographisch nicht eindeutigen, intermediären Hauptstammstenose geklärt werden, und das interventionelle Vorgehen sowie eine Optimierung der Stentimplantation werden unterstützt.
Literatur
1.
Zurück zum Zitat Neumann F‑J, Sousa-Uva M, Ahlsson A et al (2018) 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J 40:87–165CrossRef Neumann F‑J, Sousa-Uva M, Ahlsson A et al (2018) 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J 40:87–165CrossRef
2.
Zurück zum Zitat Dörr O, Möllmann H, Elsässer A et al (2018) Interventionelle Behandlung der Hauptstammstenose. Kardiologe 12:435–452CrossRef Dörr O, Möllmann H, Elsässer A et al (2018) Interventionelle Behandlung der Hauptstammstenose. Kardiologe 12:435–452CrossRef
3.
Zurück zum Zitat Stähli BE, Riedel M, Lauten A et al (2017) Intravaskulärer Ultraschall in der Behandlung der koronaren Herzkrankheit. Kardiologe 11:501–514CrossRef Stähli BE, Riedel M, Lauten A et al (2017) Intravaskulärer Ultraschall in der Behandlung der koronaren Herzkrankheit. Kardiologe 11:501–514CrossRef
4.
Zurück zum Zitat Conley MJ, Ely RL, Kisslo J et al (1978) The prognostic spectrum of left main stenosis. Circulation 57:947–952CrossRef Conley MJ, Ely RL, Kisslo J et al (1978) The prognostic spectrum of left main stenosis. Circulation 57:947–952CrossRef
5.
Zurück zum Zitat Patel MR, Calhoon JH, Dehmer GJ et al (2017) ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2017 Appropriate Use Criteria for Coronary Revascularization in Patients With Stable Ischemic Heart Disease: A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society of Thoracic Surgeons. J Am Coll Cardiol 69:2212–2241CrossRef Patel MR, Calhoon JH, Dehmer GJ et al (2017) ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2017 Appropriate Use Criteria for Coronary Revascularization in Patients With Stable Ischemic Heart Disease: A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society of Thoracic Surgeons. J Am Coll Cardiol 69:2212–2241CrossRef
6.
Zurück zum Zitat Hamilos M, Muller O, Cuisset T et al (2009) Long-term clinical outcome after fractional flow reserve-guided treatment in patients with angiographically equivocal left main coronary artery stenosis. Circulation 120:1505–1512CrossRef Hamilos M, Muller O, Cuisset T et al (2009) Long-term clinical outcome after fractional flow reserve-guided treatment in patients with angiographically equivocal left main coronary artery stenosis. Circulation 120:1505–1512CrossRef
7.
Zurück zum Zitat Motreff P, Rioufol G, Gilard M et al (2010) Diffuse atherosclerotic left main coronary artery disease unmasked by fractal geometric law applied to quantitative coronary angiography: an angiographic and intravascular ultrasound study. EuroIntervention 5:709–715CrossRef Motreff P, Rioufol G, Gilard M et al (2010) Diffuse atherosclerotic left main coronary artery disease unmasked by fractal geometric law applied to quantitative coronary angiography: an angiographic and intravascular ultrasound study. EuroIntervention 5:709–715CrossRef
8.
Zurück zum Zitat Lindstaedt M, Spiecker M, Perings C et al (2007) How good are experienced interventional cardiologists at predicting the functional significance of intermediate or equivocal left main coronary artery stenoses? Int J Cardiol 120:254–261CrossRef Lindstaedt M, Spiecker M, Perings C et al (2007) How good are experienced interventional cardiologists at predicting the functional significance of intermediate or equivocal left main coronary artery stenoses? Int J Cardiol 120:254–261CrossRef
9.
Zurück zum Zitat Oviedo C, Maehara A, Mintz GS et al (2010) Intravascular ultrasound classification of plaque distribution in left main coronary artery bifurcations: where is the plaque really located? Circ Cardiovasc Interv 3:105–112CrossRef Oviedo C, Maehara A, Mintz GS et al (2010) Intravascular ultrasound classification of plaque distribution in left main coronary artery bifurcations: where is the plaque really located? Circ Cardiovasc Interv 3:105–112CrossRef
10.
Zurück zum Zitat Mintz GS, Lefevre T, Lassen JF et al (2018) Intravascular ultrasound in the evaluation and treatment of left main coronary artery disease: a consensus statement from the European Bifurcation Club. EuroIntervention 14:e467–e474CrossRef Mintz GS, Lefevre T, Lassen JF et al (2018) Intravascular ultrasound in the evaluation and treatment of left main coronary artery disease: a consensus statement from the European Bifurcation Club. EuroIntervention 14:e467–e474CrossRef
11.
Zurück zum Zitat Finet G, Gilard M, Perrenot B et al (2008) Fractal geometry of arterial coronary bifurcations: a quantitative coronary angiography and intravascular ultrasound analysis. EuroIntervention 3:490–498CrossRef Finet G, Gilard M, Perrenot B et al (2008) Fractal geometry of arterial coronary bifurcations: a quantitative coronary angiography and intravascular ultrasound analysis. EuroIntervention 3:490–498CrossRef
12.
Zurück zum Zitat Van Zandvoort LJC, Tovar Forero MN, Masdjedi K et al (2019) References for left main stem dimensions: a cross sectional intravascular ultrasound analysis. Catheter Cardiovasc Interv 93:233–238CrossRef Van Zandvoort LJC, Tovar Forero MN, Masdjedi K et al (2019) References for left main stem dimensions: a cross sectional intravascular ultrasound analysis. Catheter Cardiovasc Interv 93:233–238CrossRef
13.
Zurück zum Zitat Fassa AA, Wagatsuma K, Higano ST et al (2005) Intravascular ultrasound-guided treatment for angiographically indeterminate left main coronary artery disease: a long-term follow-up study. J Am Coll Cardiol 45:204–211CrossRef Fassa AA, Wagatsuma K, Higano ST et al (2005) Intravascular ultrasound-guided treatment for angiographically indeterminate left main coronary artery disease: a long-term follow-up study. J Am Coll Cardiol 45:204–211CrossRef
14.
Zurück zum Zitat Jasti V, Ivan E, Yalamanchili V et al (2004) Correlations between fractional flow reserve and intravascular ultrasound in patients with an ambiguous left main coronary artery stenosis. Circulation 110:2831–2836CrossRef Jasti V, Ivan E, Yalamanchili V et al (2004) Correlations between fractional flow reserve and intravascular ultrasound in patients with an ambiguous left main coronary artery stenosis. Circulation 110:2831–2836CrossRef
15.
Zurück zum Zitat De La Torre Hernandez JM, Hernández Hernandez F, Alfonso F et al (2011) Prospective application of pre-defined intravascular ultrasound criteria for assessment of intermediate left main coronary artery lesions results from the multicenter LITRO study. J Am Coll Cardiol 58:351–358CrossRef De La Torre Hernandez JM, Hernández Hernandez F, Alfonso F et al (2011) Prospective application of pre-defined intravascular ultrasound criteria for assessment of intermediate left main coronary artery lesions results from the multicenter LITRO study. J Am Coll Cardiol 58:351–358CrossRef
16.
Zurück zum Zitat Kang SJ, Lee JY, Ahn JM et al (2011) Intravascular ultrasound-derived predictors for fractional flow reserve in intermediate left main disease. JACC Cardiovasc Interv 4:1168–1174CrossRef Kang SJ, Lee JY, Ahn JM et al (2011) Intravascular ultrasound-derived predictors for fractional flow reserve in intermediate left main disease. JACC Cardiovasc Interv 4:1168–1174CrossRef
17.
Zurück zum Zitat Park SJ, Ahn JM, Kang SJ et al (2014) Intravascular ultrasound-derived minimal lumen area criteria for functionally significant left main coronary artery stenosis. JACC Cardiovasc Interv 7:868–874CrossRef Park SJ, Ahn JM, Kang SJ et al (2014) Intravascular ultrasound-derived minimal lumen area criteria for functionally significant left main coronary artery stenosis. JACC Cardiovasc Interv 7:868–874CrossRef
18.
Zurück zum Zitat Johnson TW, Raber L, Di Mario C et al (2019) Clinical use of intracoronary imaging. Part2: acute coronary syndromes, ambiguous coronary angiography findings, and guiding interventional decision-making: an expert consensus document of the European Association of Percutaneous Cardiovascular Interventions. EuroIntervention 15:434–451CrossRef Johnson TW, Raber L, Di Mario C et al (2019) Clinical use of intracoronary imaging. Part2: acute coronary syndromes, ambiguous coronary angiography findings, and guiding interventional decision-making: an expert consensus document of the European Association of Percutaneous Cardiovascular Interventions. EuroIntervention 15:434–451CrossRef
19.
Zurück zum Zitat Galie N, Saia F, Palazzini M et al (2017) Left main coronary artery compression in patients with pulmonary arterial hypertension and angina. J Am Coll Cardiol 69:2808–2817CrossRef Galie N, Saia F, Palazzini M et al (2017) Left main coronary artery compression in patients with pulmonary arterial hypertension and angina. J Am Coll Cardiol 69:2808–2817CrossRef
20.
Zurück zum Zitat Velazquez Martin M, Montero Cabezas JM, Huertas S et al (2020) Clinical relevance of adding intravascular ultrasound to coronary angiography for the diagnosis of extrinsic left main coronary artery compression by a pulmonary artery aneurysm in pulmonary hypertension. Catheter Cardiovasc Interv. https://doi.org/10.1002/ccd.29194CrossRefPubMed Velazquez Martin M, Montero Cabezas JM, Huertas S et al (2020) Clinical relevance of adding intravascular ultrasound to coronary angiography for the diagnosis of extrinsic left main coronary artery compression by a pulmonary artery aneurysm in pulmonary hypertension. Catheter Cardiovasc Interv. https://​doi.​org/​10.​1002/​ccd.​29194CrossRefPubMed
21.
Zurück zum Zitat De Jaegere P, Mudra H, Figulla H et al (1998) Intravascular ultrasound-guided optimized stent deployment. Immediate and 6 months clinical and angiographic results from the Multicenter Ultrasound Stenting in Coronaries Study (MUSIC Study). Eur Heart J 19:1214–1223CrossRef De Jaegere P, Mudra H, Figulla H et al (1998) Intravascular ultrasound-guided optimized stent deployment. Immediate and 6 months clinical and angiographic results from the Multicenter Ultrasound Stenting in Coronaries Study (MUSIC Study). Eur Heart J 19:1214–1223CrossRef
22.
Zurück zum Zitat Zhang J, Gao X, Kan J et al (2018) Intravascular ultrasound versus Angiography-guided drug-eluting stent implantation: the ULTIMATE trial. J Am Coll Cardiol 72:3126–3137CrossRef Zhang J, Gao X, Kan J et al (2018) Intravascular ultrasound versus Angiography-guided drug-eluting stent implantation: the ULTIMATE trial. J Am Coll Cardiol 72:3126–3137CrossRef
23.
Zurück zum Zitat Raber L, Mintz GS, Koskinas KC et al (2018) Clinical use of intracoronary imaging. Part 1: guidance and optimization of coronary interventions. An expert consensus document of the European Association of Percutaneous Cardiovascular Interventions. Eur Heart J 39:3281–3300CrossRef Raber L, Mintz GS, Koskinas KC et al (2018) Clinical use of intracoronary imaging. Part 1: guidance and optimization of coronary interventions. An expert consensus document of the European Association of Percutaneous Cardiovascular Interventions. Eur Heart J 39:3281–3300CrossRef
24.
Zurück zum Zitat Kang SJ, Ahn JM, Song H et al (2011) Comprehensive intravascular ultrasound assessment of stent area and its impact on restenosis and adverse cardiac events in 403 patients with unprotected left main disease. Circ Cardiovasc Interv 4:562–569CrossRef Kang SJ, Ahn JM, Song H et al (2011) Comprehensive intravascular ultrasound assessment of stent area and its impact on restenosis and adverse cardiac events in 403 patients with unprotected left main disease. Circ Cardiovasc Interv 4:562–569CrossRef
25.
Zurück zum Zitat Ladwiniec A, Walsh SJ, Holm NR et al (2020) Intravascular ultrasound to guide left main stem intervention: a NOBLE trial substudy. EuroIntervention 16:201–209CrossRef Ladwiniec A, Walsh SJ, Holm NR et al (2020) Intravascular ultrasound to guide left main stem intervention: a NOBLE trial substudy. EuroIntervention 16:201–209CrossRef
26.
Zurück zum Zitat Park SJ, Kim YH, Park DW et al (2009) Impact of intravascular ultrasound guidance on long-term mortality in stenting for unprotected left main coronary artery stenosis. Circ Cardiovasc Interv 2:167–177CrossRef Park SJ, Kim YH, Park DW et al (2009) Impact of intravascular ultrasound guidance on long-term mortality in stenting for unprotected left main coronary artery stenosis. Circ Cardiovasc Interv 2:167–177CrossRef
27.
Zurück zum Zitat De La Torre Hernandez JM, Baz Alonso JA, Gomez Hospital JA et al (2014) Clinical impact of intravascular ultrasound guidance in drug-eluting stent implantation for unprotected left main coronary disease: pooled analysis at the patient-level of 4 registries. JACC Cardiovasc Interv 7:244–254CrossRef De La Torre Hernandez JM, Baz Alonso JA, Gomez Hospital JA et al (2014) Clinical impact of intravascular ultrasound guidance in drug-eluting stent implantation for unprotected left main coronary disease: pooled analysis at the patient-level of 4 registries. JACC Cardiovasc Interv 7:244–254CrossRef
29.
Zurück zum Zitat Gao XF, Kan J, Zhang YJ et al (2014) Comparison of one-year clinical outcomes between intravascular ultrasound-guided versus angiography-guided implantation of drug-eluting stents for left main lesions: a single-center analysis of a 1,016-patient cohort. Patient Prefer Adherence 8:1299–1309CrossRef Gao XF, Kan J, Zhang YJ et al (2014) Comparison of one-year clinical outcomes between intravascular ultrasound-guided versus angiography-guided implantation of drug-eluting stents for left main lesions: a single-center analysis of a 1,016-patient cohort. Patient Prefer Adherence 8:1299–1309CrossRef
30.
Zurück zum Zitat Tian J, Guan C, Wang W et al (2017) Intravascular ultrasound guidance improves the long-term prognosis in patients with unprotected left main coronary artery disease undergoing Percutaneous coronary intervention. Sci Rep 7:2377CrossRef Tian J, Guan C, Wang W et al (2017) Intravascular ultrasound guidance improves the long-term prognosis in patients with unprotected left main coronary artery disease undergoing Percutaneous coronary intervention. Sci Rep 7:2377CrossRef
31.
Zurück zum Zitat Kinnaird T, Johnson T, Anderson R et al (2020) Intravascular imaging and 12-month mortality after unprotected left main stem PCI: an analysis from the British cardiovascular intervention society database. JACC Cardiovasc Interv 13:346–357CrossRef Kinnaird T, Johnson T, Anderson R et al (2020) Intravascular imaging and 12-month mortality after unprotected left main stem PCI: an analysis from the British cardiovascular intervention society database. JACC Cardiovasc Interv 13:346–357CrossRef
32.
Zurück zum Zitat De La Torre Hernandez JM, Garcia Camarero T, Baz Alonso JA et al (2020) Outcomes of predefined optimisation criteria for intravascular ultrasound guidance of left main stenting. EuroIntervention 16:210–217CrossRef De La Torre Hernandez JM, Garcia Camarero T, Baz Alonso JA et al (2020) Outcomes of predefined optimisation criteria for intravascular ultrasound guidance of left main stenting. EuroIntervention 16:210–217CrossRef
33.
Zurück zum Zitat Ye Y, Yang M, Zhang S et al (2017) Percutaneous coronary intervention in left main coronary artery disease with or without intravascular ultrasound: a meta-analysis. PLoS ONE 12:e179756CrossRef Ye Y, Yang M, Zhang S et al (2017) Percutaneous coronary intervention in left main coronary artery disease with or without intravascular ultrasound: a meta-analysis. PLoS ONE 12:e179756CrossRef
34.
Zurück zum Zitat Wang Y, Mintz GS, Gu Z et al (2018) Meta-analysis and systematic review of intravascular ultrasound versus angiography-guided drug eluting stent implantation in left main coronary disease in 4592 patients. BMC Cardiovasc Disord 18:115CrossRef Wang Y, Mintz GS, Gu Z et al (2018) Meta-analysis and systematic review of intravascular ultrasound versus angiography-guided drug eluting stent implantation in left main coronary disease in 4592 patients. BMC Cardiovasc Disord 18:115CrossRef
35.
Zurück zum Zitat Elgendy IY, Gad M, Jain A et al (2019) Outcomes with intravascular ultrasound-guided drug eluting stent implantation for unprotected left main coronary lesions: a meta-analysis. Am J Cardiol 124:1652–1653CrossRef Elgendy IY, Gad M, Jain A et al (2019) Outcomes with intravascular ultrasound-guided drug eluting stent implantation for unprotected left main coronary lesions: a meta-analysis. Am J Cardiol 124:1652–1653CrossRef
36.
Zurück zum Zitat Tan Q, Wang Q, Liu D et al (2015) Intravascular ultrasound-guided unprotected left main coronary artery stenting in the elderly. Saudi Med J 36:549–553CrossRef Tan Q, Wang Q, Liu D et al (2015) Intravascular ultrasound-guided unprotected left main coronary artery stenting in the elderly. Saudi Med J 36:549–553CrossRef
37.
Zurück zum Zitat Liu XM, Yang ZM, Liu XK et al (2019) Intravascular ultrasound-guided drug-eluting stent implantation for patients with unprotected left main coronary artery lesions: A single-center randomized trial. Anatol J Cardiol 21:83–90CrossRef Liu XM, Yang ZM, Liu XK et al (2019) Intravascular ultrasound-guided drug-eluting stent implantation for patients with unprotected left main coronary artery lesions: A single-center randomized trial. Anatol J Cardiol 21:83–90CrossRef
38.
Zurück zum Zitat Gao X‑F, Ge Z, Kong X‑Q et al (2021) Three-Year Outcomes of the ULTIMATE Trial Comparing Intravascular Ultrasound Versus Angiography-Guided Drug-Eluting Stent Implantation. JACC Cardiovasc Interv 14:247–257CrossRef Gao X‑F, Ge Z, Kong X‑Q et al (2021) Three-Year Outcomes of the ULTIMATE Trial Comparing Intravascular Ultrasound Versus Angiography-Guided Drug-Eluting Stent Implantation. JACC Cardiovasc Interv 14:247–257CrossRef
Metadaten
Titel
Intravaskulärer Ultraschall bei der Beurteilung und Intervention von Hauptstammläsionen
verfasst von
Prof. Dr. med. Julian D. Widder
Publikationsdatum
08.03.2021
Verlag
Springer Medizin
Erschienen in
Die Kardiologie / Ausgabe 2/2021
Print ISSN: 2731-7129
Elektronische ISSN: 2731-7137
DOI
https://doi.org/10.1007/s12181-021-00469-6

Weitere Artikel der Ausgabe 2/2021

Die Kardiologie 2/2021 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.