血管内超声基础知识和在冠脉介入中的应用浙江大学医学院附课件

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1、血管内超声基础知识和在冠脉介入中的应用浙江大学医学院附属第二医院心内科项美香内容一、IVUS基础二、IVUS对冠脉病变的诊断作用三、IVUS对冠脉介入治疗的指导作用四、什么是VH？什么是IVUSIntraVasocularUltraSoundAdetectiondevicereceivessoundwavesRotatingElementDriveShaftMulti-elementArray超声导管机械旋转型和电子相控阵型工作原理TheIVUSTransducerinthecathetertipemitsHigh-frequencysoundwav

2、es(MHz)throughblood(conductive)Transducer:Devicetoconvertelectricalenergyintosoundenergyandviceversa工作原理Afterreflectionfromtissue,thesesamesoundwavesreturntothecrystal(transducer)thatproducesanelectricalimpulsethatisthenconvertedintotheimage.electricalimputsoundSoundreflectedele

3、ctricaloutputThesystemcreatesaCross-sectionalimagebasedontheintensityofthereturnedWaves.工作原理HighfrequencysoundwavesechooffvesselwallsandaresentbacktosystemSystemelectronicsprocessthesignalSending,Receiving,ProcessingSoundWavestocreateaCross-sectionalpictureofanarteryHighfrequenc

4、ysoundwavesechooffvesselwallsandaresentbacktosystemSystemelectronicsprocessthesignalSending,Receiving,ProcessingSoundWavestocreateaCross-sectionalpictureofanarteryIVUS与冠状动脉造影CAG:血管的轮廓局部的病变偏心性斑块IVUS:血管壁和血管腔的结构斑块的负荷斑块的组成和性质IVUS血栓夹层壁内血肿心肌桥模糊病变Brightechoes(brighterthantheadventitia)

5、Obstructsthepenetrationofultrasound(acousticshadowing)onlytheleadingedgeisdetectedandthicknesscannotbedetermined.Resultsinreverberations-theoscillationofultrasoundbetweentransducerandcalciumcausingrepeating‘arcs’斑块的性质：钙化斑块80°SuperficialDeepDeepCalciumisclassifiedbyitslocationwit

6、hintheplaqueSuperficialcalciumisclosertothelumenthantotheadventitiaDeepcalciumisclosertotheadventitiathantothelumen分类：浅层和深层钙化分型：0-IV纤维化斑块Asbrightorbrighterthantheadventitia(hyperechoic)MajorityofatheroscleroticlesionsarefibroticVerydense,fibrousplaquesmaycausesomuchacousticshado

7、wingthattheycouldbemisclassifiedascalcified软斑块Notasbrightastheadventitia(hypoechoic)“Soft”referstothelowechogenicity,generallyduetohighlipidcontentinamostlycellularlesion.Reducedechodensitymayalsobedueto:necroticzonewithinplaqueintramuralhemorrhagethrombus易损斑块--VPFibrousCapLipid

8、Core混合性斑块衰减斑块(Attenuatedplaque)Hypoechoicormixe