探讨应用光学相干断层成像技术(OCT)，观察临床表现为非ST段抬高型急性冠脉综合征患者冠状动脉斑块破裂的影像学诊断特征。

分析1例临床表现为急性冠脉综合征患者的临床资料，分别比较冠状动脉血管造影、血管内超声(IVUS)及OCT技术对罪犯病变的判断。

患者临床表现为反复加重的静息情况下胸痛，体格检查未见异常，胸片显示正常；心电图示Ⅱ、Ⅲ、avF导联出现q/Q波，V₅～V₆导联T波倒置；心肌特异性标志物肌钙蛋白Ⅰ为0.20 mg/L(正常<0.04 mg/L)；心脏多普勒超声显示下壁运动局限性减弱，心脏射血分数为50%；冠状动脉造影显示：前降支支架内未见明显狭窄，左回旋支慢性闭塞病变(与8个月前显示一致)，右冠状动脉粗大，近段轻度狭窄(30%～40%)，斑块显示不稳定；IVUS显示右冠状动脉近段斑块面积负荷73%狭窄，血管最小管腔面积5.80 mm² ，并伴有假腔的形成，斑块特征显示不清晰；OCT结果显示该斑块含有薄的纤维帽(0.70 μm)，纤维帽下富含较大的脂质核心斑块，并伴有斑块的破裂和内膜撕裂。

应用OCT技术能够发现急性冠脉综合征患者的罪犯病变。

To explore the imaging features of patients with non-ST elevation acute coronary syndrome (ACS) using optical coherence tomography(OCT).

The clinical data of one patient with ACS were analyzed.The coronary culprit vascular lesions were detected by coronary angiography, intravenous ultrasound(IVUS) and OCT, respectively.

The patient presented with repeately progressive chest pain at rest.Physical examination and chest X-ray results were normal.Electrocardiogram (ECG) showed a q/Q wave in Ⅱ, Ⅲ, and avF leads and inverted T wave in V₅~V₆, cardiac troponin I level was 0.20 mg/L (the normal value was <0.04 mg/L). Transthoracic echocardiography manifested left ventricular ejection fraction as 50% with weak inferior wall motion.The coronary angiogram presented that stents in left anterior descending(LAD) were normal.The left circumflex artery showed total occlusion similar to the last procedure, which was performed 8 months ago.A large right coronary artery with a slight stenotic lesion in the proximal artery was found.IVUS images demonstrated that the right coronary stenotic lesion had a false lumen, the plaque burden was 73% and the minimum lumen area was 5.80 mm².OCT results exhibited that the plaque contained a thin fibrous cap (0.70 μm), which was rich in lipid, accompained by plaque rupture and intimal tear.

The coronary culprit vascular lesions of ACS can be detected by using OCT technique.