Kusaba, Hiroyasu; Watanabe, Kazuo; Shiraishi, Shohzo; Sato, Takashi; Koga, Nobuhiko
We have evaluated the angioscopic findings before and after various percutaneous techniques to treat 39 lesions in 32 cases of arteriosclerosis obliterans (ASO). We applied a laser (CL50: SLT, Japan), percutaneous transluminal angioplasty (PTA), and atherectomy -- either singly or in combination, with angioscopic luminal observation (angioscope: PF14L & PF18L Olympus, Japan) recorded before and after the treatments. In the case of a complete obstruction, we employed PTA as the first choice. We used a laser prior to PTA when the PTA guide-wire failed to penetrate the lumen. For eccentric and calcified lesions atherectomy was applied. A sufficient enlargement was obtained initially in 37 of the 39 lesions. The angioscopic observations after treatment revealed carbonization (3/5) and attachment of small thrombi (3/5) after using the laser, intimal rupture (3/8), dissection (2/8), flap formation (2/8), and attachment of small thrombi (4/8) after PTA, and attachment of small thrombi (9/19), flap formation (6/19), and dissection (2/19) after atherectomy. We established the efficacy of angioscopic assessment demonstrating beneficial clinical results. The angioscopic findings suggest that attachment of small thrombi may be responsible for a poor prognosis. Additional angioscopic observations with angiography are recommended for improved understanding of the luminal changes.
Kawasaki disease is an acute systematic angiitis, specifically affecting the coronary arteries in young children. Coronary aneurysms develop in 10 to 15% of patients with Kawasaki disease. The coronary aneurysm frequently changes into coronary stenosis and obstruction. Hitherto, we could observe and access the severity of these coronary lesions with the use of two dimensional echocardiography and selective coronary angiography. Angiography is the most sensitive means available for diagnosing significant coronary lesions and their severity. However, it is insensitive for detecting intraluminal minute and pathologic changes such as intimal thickening, regeneration of endothelium and thrombus. Recent advance in fiberscopie technology, enabled us to observe the inside of coronary artery percutaneously. We tried to use this angioscopic technique for the observation of coronary lesions in eight patients with Kawasaki disease at chronic stage.
Xu, S; Nomura, M; Kurokawa, H; Ando, T; Kimura, M; Ishii, J; Hasegawa, H; Kondo, T; Tadiki, S; Qi, P
In order to investigate the relationship between restenosis and the morphology detected by coronary angioscopy (CASC) and introvascular ultrasound imaging (IVUS), 17 patients were detected by CASC and IVUS immediately and 3 months after percutaneous transluminal coronary angioscopy (PTCA). The results showed that the dilation index by IVUS (DIu) was significantly lower in restenosis patients than in non-restenosis patients (0.42 +/- 0.08 versus 0.78 +/- 0.16, P < 0.01) and that the elastic recoil (ER) was higher in restenosis patients than in non-restenosis patients (4.51 +/- 1.42 mm2 versus 1.63 +/- 1.20 mm2, P < 0.01), and that the elastic recoil rate (ERR) was also higher in restenosis patients than in non-restenosis patients (57.3 +/- 8.07% versus 21.80 +/- 16.84% P < 0.01), and that coronary dissection, atheromatous plaque and calcification as well as the colour of inner coronary artery had no relation with chronic restenosis. In conclusion, the elastic recoil is one of the important factors of chronic restenosis after PTCA.
Ishibashi, Fumiyuki; Lisauskas, Jennifer B; Kawamura, Akio; Waxman, Sergio
Yellow plaques seen during coronary angioscopy are thought to be the surrogates for superficial intimal lipids in coronary plaque. Given diffuse and heterogeneous nature of atherosclerosis, yellow plaques in coronaries may be seen as several yellow spots on diffuse coronary plaque. We examined the topographic association of yellow plaques with coronary plaque. In 40 non-severely stenotic ex-vivo coronary segments (average length: 52.2 +/- 3.1 mm), yellow plaques were examined by angioscopy with quantitative colorimetry. The segments were cut perpendicular to the long axis of the vessel at 2 mm intervals, and 1045 slides with 5 microm thick tissue for whole segments were prepared. To construct the plaque surface, each tissue slice was considered to be representative of the adjacent 2 mm. The circumference of the lumen and the lumen border of plaque were measured in each slide, and the plaque surface region was constructed. Coronary plaque was in 37 (93%) of 40 segments, and consisted of a single mass [39.9 +/- 3.9 (0-100) mm, 311.3 +/- 47.4 (0.0-1336.2) mm2]. In 30 (75%) segments, multiple (2-9) yellow plaques were detected on a mass of coronary plaque. The number of yellow plaques correlated positively with coronary plaque surface area (r = 0.77, P colorimetry, some of them are associated with lipid cores underneath thin fibrous caps, may be used to assess the extent of coronary plaque. Further research using angioscopy could be of value to study the association of high-risk coronaries with acute coronary syndromes.
Baudrillard, J C; Foucart, H; Defache, C H; Lerais, J M; Cécile, J P
Since 1987, the authors have routinely combined angioscopy with angioplasty of peripheral arteries. In a series of 251 angioplasties carried out in 191 patients, angioscopy was found to be more specific and more sensitive than arterial angiography in the etiological diagnosis of arterial stenoses and/or obstructions. Angioscopic findings modified the angioplasty procedure in 29% of cases. Using an inflatable catheter remains the most commonly used approach (230 cases); in 10 cases, this was preceded by thromboaspiration and in 4 cases by dotterization. Angioscopic support was useful in carrying out difficult manoeuvres (monitoring of the angioplasty in 4 cases, correct orientation of the guide into the lumen in 14 cases, installation of an endoprosthesis in 9 cases, arterial biopsy in 5 cases and sampling of an atheroma in 8 cases).
Baudrillard, J C; Cécile, J P; Foucart, H; Carlier, C; Baidj, Z
Angioscopy is a technique of endoscopic investigation of the vascular lumen and its contents, which we have coupled with iliac and femoral angioplasty. The material comprises 3 main elements: the angioscope, the TV-monitoring assembly and the infusion system. No complication was recorded in a series of 94 angioscopies (47 iliac, 44 distal femoral and 3 grafts) performed over a period of 18 months. The technical quality of the images obtained was good in 90% of cases (85/94). Angioscopy revealed lesions that had either been nonvisualized or underrated by angiography, and played a determinant role in 16% of cases (15/94), whereby the therapeutical procedure could be modified accordingly.
Zembala, Michal O; Irimie, Vadim; Urbanski, Paul P
A rare case of aortic arch aneurysm combined with chronic aortic dissection is reported. Because the visceral arteries originated from different, equivalently perfused lumens and the descending aorta was circumferentially calcified (porcelain aorta) limiting the possibilities of anastomosing, careful planning of the surgical strategy was of utmost importance. The complex surgery consisted of ascending and total arch replacement using the 'frozen elephant trunk' technique with Thoraflex™ Hybrid Prosthesis (Vascutek, Terumo, Inchinnan, Scotland); however, before insertion of the stent graft, an angioscopic resection of the dissection membrane in the proximal part of the descending aorta was carried out to ensure a complete expansion of the distal edge of the stent within the entire common lumen of the aorta and unimpaired distal flow in both lumens below the stent graft. The surgery and the postoperative course were uneventful.
Foucart, H; Baudrillard, J C; Carlier, C; Cécile, J P
Since 1987, routine angioscopic examination has been performed in 191 patients undergoing angioplasty, with interventions (196) after a 2 year surveillance period (55). Angioscopy allowed follow up "de visu" of the performance of angioplasty, details of its mechanism to be precise and under dilatation to be carried out. For femoral artery occlusions it allowed treatment "à la carte": conventional dilatation of vegetating atheroma, specific treatment of established thrombi (5) and abstention from therapy of atheroma covered by endothelium (3). It also enabled fresh thrombi complicating a stenosis or at the origin of a thrombus to be detected. The extraction technique employed (15) is described. It facilitated catheterization by directing the probe, enabled avoidance of bypassing of stenosis and flaps and of dissection or false introduction into collaterals (10). Directed biopsy could be carried out in inflammatory arteritis (7). Vegetating atheromatous lesions could be opened and extracted, facilitating subsequent dilatation and allowing an approach to removal of iliac artery obstructions without major risks of complications (13). Finally, after an ineffective dilatation or the presence of a dissection, it assisted making the decision to introduce a stent (9), the tolerance and outcome of these stents are described. Or the 196 patients considered suitable for angioplasty, our therapeutic conduct was modified by angioscopy in 58 cases (29%). Not simply a new diagnostic tool, it plays a role in interventional vascular techniques.
Ishibashi, Fumiyuki; Mizuno, Kyoichi; Kawamura, Akio; Singh, Premranjan P; Nesto, Richard W; Waxman, Sergio
High yellow color intensity (HYCI) regions of atherosclerotic plaque, determined by angioscopy with quantitative colorimetry, are associated with lipid cores underneath thin fibrous caps in ex vivo tissue samples. To determine whether HYCI regions of coronary plaque are associated with disruption or thrombus in living patients, quantitative colorimetry was applied to angioscopy, and the color of culprit lesions was measured in patients with acute coronary syndromes. In 46 patients with acute coronary syndromes (acute myocardial infarction, n = 14; unstable angina pectoris [UAP] with culprit thrombus, n = 16; and UAP without culprit thrombus, n = 16), the recorded angioscopic images of culprit lesions were analyzed using a quantitative colorimetric method based on the L*a*b* color space applied to angioscopy (positive b* = yellow color intensity). HYCI was defined as b* value >23. Plaque disruption was significantly more prevalent in 19 of 24 HYCI regions (79%) than in 9 of 22 non-HYCI regions (41%) (p = 0.007). Culprit HYCI regions were prevalent in patients with myocardial infarction (11 of 14 [79%]), followed by those with UAP with thrombus (9 of 16 [56%]) and UAP without thrombus (4 of 16 [25%]) (p = 0.01 for trend), and were significantly more prevalent in 66% of patients with myocardial infarction and UAP with thrombus compared with 25% of those with UAP without thrombus (p = 0.007). In conclusion, HYCI regions of coronary plaque may be indicative of high-risk lesions vulnerable to thrombosis. Coronary angioscopy with quantitative colorimetry could be used to study the association between high-risk coronary lesions and future cardiovascular events.