Abstract: Introduction: one of directions in development of intravascular diagnostic methods is creation of stations or development of methods that allow combining or uniting possibilities of different modalities. This approach makes it possible to overcome limitations inherent in each method of invasive vascular diagnostics, including angiography. This work is devoted to the analysis of possibilities and first results of using the SyncVision station (Philips Volcano), which allows, in various combinations, to carry out joint registration of angiography data, intravascular ultrasound (IVUS) and instantaneous blood flow reserve (iFR) in various combinations - a non-hyperemic version of fractional flow reserve study. Aim: was to describe possibilities provided by the use of joint recording of data from angiography, IVUS and real-time instantaneous blood flow reserve, the technique for performing these procedures, as well as to analyze the application of these methods in a department with a large volume of intravascular studies. Material and methods: the first experience in Russian Federation of the clinical use of the SyncVision station, which is an addition to the s5i intravascular ultrasound system (Philips Volcano), is presented. The station allows you to implement five options that expand the operator's ability to analyze study data and develop a treatment strategy directly at the operating table: co-registration of angiography and intravascular ultrasound (IVUS) data; co-registration of angiography data and instantaneous flow reserve (iFR); triple co-registration - angiography, IVUS and iFR; modification of the program for the quantitative calculation of coronary artery stenosis (QCA); real-time image enhancement software for interventional devices. Results: studies using co-registration with angiography accounted for 21% of all IVUS procedures and 62,4% of iFR procedures. In 67,3% of all studies with angio-IVUS co-registration, the indication for this diagnostic variant was an extended lesion of artery, which required clarification of length of stenotic area, localization of reference segments, and diameter of artery at different levels. In 30 of these patients, triple co-registration was performed. To clarify the hemodynamic significance of lesion with an angiographically indeterminate or borderline picture, co-registration was performed in 13,2% of all cases, to study a bifurcation lesion with a significant difference in the reference segments and angiographically difficult to determine the entry of lateral branch - in 7,3%. Based on results of triple co-registration, the decision to perform surgical treatment was made in 30 out of 42 patients (71,4%). Conclusion: joint registration of IVUS data, coronary angiography, and instantaneous flow reserve (iFR) in real time, forms a new diagnostic modality that significantly expands possibilities of intraoperative examination and affects the planning or analysis of intervention results.
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Abstract: Introduction: the importance of intravascular diagnostic methods and the frequency of their use in clinical practice is steadily increasing. However, in the Russian Federation, studies on the analysis of possibilities of intravascular imaging or physiology are sporadic, and statistical data are presented only in very generalized form. This makes it relevant to create a specialized register dedicated to these diagnostic methods. Aim: was to present the structure, tasks and possibilities of the Russian registry for the use of intravascular imaging and physiology based on results of the first year of its operation. Material and methods: In total, in 2021, forms were filled out for 2632 studies in 1356 patients. Studies included all types of intravascular imaging and physiology - intravascular ultrasound, optical coherence tomography, measurement of fractional flow reserve and non-hyperemic indices. The registry's web-based data platform includes 14 sections and 184 parameters to describe all possible scenarios for applying these methodologies. Data entry is possible both from a stationary computer and from mobile devices, and takes no more than one minute per study. Received material is converted into Excel format for further statistical processing. Results: 13 departments participated in the register, while the share of the eight most active ones accounted for 97,5% of all entered forms. On average, 1.9 studies per patient were performed, with fluctuations between clinics from 1,6 to 2,9. Studies of the fractional flow reserve accounted for 40% of total data array, intravascular ultrasound - 37%, optical coherence tomography - 23%. Of all studies, 80% were performed on coronary arteries for chronic coronary artery disease, 18% - for acute coronary syndrome, 2% were studies for non-coronary pathology. In 41% of cases, studies were performed at the diagnostic stage, without subsequent surgery. In 89,6% of cases, this was due to the detection of hemodynamically insignificant lesions, mainly by means of physiological assessment. In 72% of cases, the use of intravascular imaging or physiology methods directly influenced the tactics or treatment strategy - from deciding whether to perform surgery or not to choose the optimal size of instruments or additional manipulations to optimize the outcome of the intervention. In the clinics participating in the register, the equipment of all major manufacturers represented on the Russian market was used. Conclusions: the design of the online registry database is convenient for data entry. Participation in the registry of most departments that actively and systematically use methods of intravascular imaging and physiology ensured the representativeness of obtained data for analysis in interests of both practical medicine and industry, as well as for scientific research in the field of intravascular imaging and physiology. The register has great potential for both quantitative and qualitative improvement.
Abstract: Introduction: development of intravascular diagnostic methods has significantly increased the amount of information in the study of various vessels in comparison with standard angiography. Technological and software improvement of optical coherence tomography (OCT) allows expanding diagnostic capabilities and providing greater convenience for analyzing of results of this method of intravascular examination, which leads to an increase in its importance both for daily clinical practice and in scientific research. Aim: was to describe the methodology of performing a new modification of OCT and to analyze accumulated experience, advantages and possibilities provided by this method. Material and methods: the modern version of the complex for optical coherence tomography OPTIS allows to implement such new features as automatic indication of malapposition of stents, easy-to-perceive three-dimensional image of examination data in various versions, joint presentation (co-registration) of angiography and OCT data in real time. The first experience of clinical use of this system in the Russian Federation is presented, with an analysis of priority indications for the use of new possibilities. Using the angio-OCT-co-registration function, 309 studies of 205 arteries in 178 patients were performed, which accounted for 63,3% of all OCT procedures performed in our department. Results: priority indications for the use of the method were identified, which primarily include: cases of extended stenoses with an uncertainty in the hemodynamic significance of individual sections or the entire lesion as a whole; difficulties in constructing an optimal projection of the angiogram (without overlapping branches and significant shortening of the target area); bifurcation lesions; diagnostics of thrombus, dissections, plaque ruptures, severe calcification, including in acute coronary syndrome; selection of the optimal size of biodegradable scaffold and preparation of the artery for its implantation; intermediate or final control of results of coronary artery stenting. The use of co-registration of angiography and OCT contributes to a more accurate determination of the area of interest during repeated studies, which is especially important for the dynamic assessment of the patient's condition and for scientific research. Conclusions: the development and modernization of optical coherence tomography causes an increase in its importance both in daily clinical practice and in scientific research. The possibility of spatial co-registration of OCT data with angiographic images, as well as new options for automatic processing of resulting images, including stent apposition assessment, significantly increase the operator's ability to quickly and accurately analyze examination data directly at the operating table. References 1. Demin VV. Clinical guide to intravascular ultrasound. Orenburg. Yuzhnyj Ural. 2005: 400 [In Russ]. 2. Raber L, Mintz GS, Koskinas KC, et al. 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. EuroIntervention. 2018; 14: 656-677. https://doi.org/10.4244/EIJY18M06_011 3. Johnson TW, Raber L, di Mario C, et al. 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