METHOD OF OPTICAL COHERENCE TOMOGRAPHY FOR INTRAOPERATIVE HISTOMORPHOLOGICAL ASSESSMENT OF CORONARY CONDUITS INTEGRITY WHEN CORONARY ARTERY BYPASS GRAFTING

摘要

FIELD: medicine.;SUBSTANCE: invention relates to medicine, namely to cardiovascular surgery, namely to intravascular research methods, and can be used for intraoperative histomorphological assessment of the integrity of coronary conduits for coronary artery bypass grafting (CABG). During the CABG operation, at the stage of conduit sampling, intraoperative optical coherence tomography (OCT) of prospective autovenous and/or autoarterial conduits is performed, choosing anatomically and histologically optimal areas of the vessel for use as a coronary shunt by passability assessment and performing a histomorphological analysis of the coronary artery vascular wall in the zone of the distal anastomosis, the zone of the distal anastomosis itself, as well as the internal lumen of the conduit and its wall. At the time of completion of the CABG surgery main stage, intraoperative OCT of venous and/or arterial shunts is combined with intraoperative shuntography with a detailed assessment of the shunt body and the distal anastomosis zone. In the study perform selective catheterization of the mouth of the investigated shunt guidewire catheter. Coronary guide is passed through the entire conduit beyond the distal anastomosis zone. Catheter with a sensor for OCT is delivered via a coronary guide. Under X-ray control, the OCT catheter is positioned so that the radiopaque marker of the distal lens extends beyond the distal anastomosis into the coronary artery. Create an optically homogeneous medium in the lumen of the shunt under study, for which a contrast agent is injected into the lumen of the shunt under study before scanning. Achievement of optical homogeneity is monitored on the OCT system screen in the “live view” mode. After the creation of an optically homogeneous medium in the lumen of the vessel under investigation, the OCT sensor is drawn through and then the image is started in manual mode at a speed of 10 mm/s. During visualization, the Grayscale or Sepia protocol is used, as well as the mode that generates a longitudinal section of the investigated area of the conduit along its entire length.;EFFECT: method allows intraoperative histomorphological assessment of the vascular wall of the coronary artery in the area of the distal anastomosis, anastomosis and conduit wall during the bypass surgery due to OCT during the operation.;4 cl