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.
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.
Marinello, J; Alós, J
Possibilities from arterial and venous angioscopy in the diagnostic, angioplasty and surgical protocols are analyzed. Indications for angioscopy, additional informations compared to angiography and potentials for endovascular therapy guided by angioscopy will be discussed according to personal preliminary experience and review of the bibliography.
Cécile, J P; Foucart, H; Carlier, C; Baudrillard, J C; Varloteaux, M C; Servais, B; Bourgois, L
Very few papers about peripheral angioscopy are reported in literature. Percutaneous angioscopy (P.T.A.) of 25 peripheral arteries (21 iliac and 4 femoral arteries) have been performed by the authors without surgery and without anesthesia. Three observations are selected. The first one demonstrates an eccentric stenosis altering its diameter during pulsations; an irregular ulcerated atheroma is observed. The second case shows the signs of a centric atheroma with an intimal fragment. The last one is an intimal dissection due to PTA. The prospective aspects of this new technique are discussed.
Baudrillard, J C; Foucart, H; Carlier, C; Cécile, J P
The historical background to angioscopy shows that the principal successes recorded by its use result from the miniaturization of fibroscopes and the progress in video imaging. The first tentative use of angioscopy was by surgeons during operations carried out at about 1970, that of percutaneous angioscopy dating from 1984. The material used for diagnostic (fibroscope, cinecamera, video system, flushing pump) and interventional (fibroscope, clamps, Dormia cage, endoprostheses ... ) angioscopy is such that the basic equipment requires an outlay of about 150 to 200,000 francs. Percutaneous angioscopy implies the insertion of a catheter allowing flushing of the arterial lumen by means of a pressurized perfusion pump which, when reversed, is transformed into an aspirating pump for removal of the clot and/or atheromatous debris. The procedure is simple and does not expose to more complications than conventional arteriography.
Cécile, J P; Baudrillard, J C; Carlier, C; Foucart, H; Page, P; Eckstein, U
Because of the poor specificity of the arteriography, the authors have performed a percutaneous angioscopy before every angioplasty of the arteries of lower limbs for nearly 3 years. They define the angioscopy and describe materials and technique. The percutaneous route without surgery and without anesthesia underlines the originality of the technique. The great difficulty is to counter-pulse the arterial inflow. The rate of saline irrigation and all the means of arterial blockade are described. In the second part, the "elementary images" are classified. The authors insist on the specificity of the angioscopy in the interpretation of arterial obstructions. Because of this specificity, the right treatment can be applied to any type of lesion. Angioscopy permits to foresee endoluminal surgery technique.
van Ooijen, Peter M. A.; de Jonge, Gonda; Oudkerk, Matthijs
Coronary fly-through or virtual angioscopy (VA) has been studied ever since its invention in 2000. However, application was limited because it requires an optimal computed tomography (CT) scan and time-consuming post-processing. Recent advances in post-processing software facilitate easy constructio
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).
Komatsu, Sei; Ohara, Tomoki; Takahashi, Satoru; Takewa, Mitsuhiko; Yutani, Chikao; Kodama, Kazuhisa
Non-obstructive angioscopy (NOA) is used to visualize the surface of the coronary artery, and a clear visual field is obtained by injecting transparent fluid into the gap between the probing catheter and the fiber. This study examines visual field expansion by a dual infusion method, which involves an infusion from the probing and guiding catheters, and the relationships between visual grade and vessel characteristics. Thirty-two patients and thirty patients performed coronary plaque analysis with NOA using the conventional method and the novel dual infusion method, respectively. Images were blindly analyzed retrospectively. Visual fields were assessed from image slices using a 5-point scale (0 = invisible, 1 = poor, 2 = adequate, 3 = good, 4 = excellent) at 5-s intervals. The relationships between visual grade and vessel characteristics were analyzed using multiple stepwise linear regression analysis. The mean visual grade, "excellent" ratio, and "adequate" ratio were significantly higher using the dual infusion method than those obtained using the conventional method (p = 0.003, p = 0.004, and p = 0.005 respectively). The "invisible" ratio was significantly lower using the dual infusion method than the conventional method (p = 0.027). The visual field was negatively associated with the conventional method (β = -0.154, p visual field with NOA can be effectively expanded by the dual infusion method.
van Ooijen, Peter M A; de Jonge, Gonda; Oudkerk, Matthijs
Coronary fly-through or virtual angioscopy (VA) has been studied ever since its invention in 2000. However, application was limited because it requires an optimal computed tomography (CT) scan and time-consuming post-processing. Recent advances in post-processing software facilitate easy construction of VA, but until now image quality was insufficient in most patients. The introduction of dual-source multidetector CT (MDCT) could enable VA in all patients. Twenty patients were scanned using a dual-source MDCT (Definition, Siemens, Forchheim, Germany) using a standard coronary artery protocol. Post-processing was performed on an Aquarius Workstation (TeraRecon, San Mateo, Calif.). Length travelled per major branch was recorded in millimetres, together with the time required in minutes. VA could be performed in every patient for each of the major coronary arteries. The mean (range) length of the automated fly-through was 80 (32-107) mm for the left anterior descending (LAD), 75 (21-116) mm for the left circumflex artery (LCx), and 109 (21-190) mm for the right coronary artery (RCA). Calcifications and stenoses were visualised, as well as most side branches. The mean time required was 3 min for LAD, 2.5 min for LCx, and 2 min for the RCA. Dual-source MDCT allows for high quality visualisation of the coronary arteries in every patient because scanning with this machine is independent of the heart rate. This is clearly shown by the successful VA in all patients. Potential clinical value of VA should be determined in the near future.
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.
李新平; 陈伟; 朱智明
[ Objective ] To explore the clinical value of CT virtual angioscopy (CTVA) in the pre- and postpro-cedure evaluation of aortic arch related diseases. [Methods] 37 cases with thoracic disease underwent aortic CT angiography on a dual-source CT scanner. CTVA of aortic arch were performed with Fly-through software in all cas-? Es by using aortic CT angiographic source image data. [Results] 34 of 37 (92%) cases showed successful CTVA images, including aortic dissection (n =12), aneurysm (n =4), pseudoaneurysm (n =3), Takayasu arteritis (n =2),aortic coarctation (n =1), aneurysm combined with aortic dissection (n =1) and 11 patients following surgical or endovascu-lar procedures. CTVA of aortic arch could identify the ostia and its variations of supra-aortic vessels, estimate the localization of abnormalities with respect to supra-aortic vessels and display the stent grafts. [ Conclusions ] CTVA of aortic arch enables non-invasive visualization of the inner contours of the vasculature, and has certain instructive significance in the diagnostic classification, preprocedure planning and postprocedure evaluation for aortic arch related diseases.%目的 探讨CT仿真血管内镜(CTVA)在主动脉弓相关疾病术前和术后评价中的价值.方法 采用双源CT对37例胸主动脉疾病患者行主动脉CT成像检查,并将主动脉CT成像的源图像调至Fly-through软件中,对所有病例行主动脉弓CTVA观察.结果 92％(34/37)的病例获得了满意的CTVA图像,包括主动脉夹层12例、真性动脉瘤4例、假性动脉瘤3例、多发性大动脉炎2例、主动脉缩窄1例、真性动脉瘤合并夹层1例及11例术后随访病例.主动脉弓CTVA能明确弓上分支血管开口位置与变异、判断病变与弓上分支开口的空间关系以及显示支架型血管.结论 主动脉弓CTVA能无创观察血管腔内情况,对主动脉弓相关疾病的诊断分型、术前计划和术后评价具有一定的指导意义.
Carlier, C; Foucart, H; Baudrillard, J C; Cécile, J P
Efficacy of percutaneous treatments of arterial affections requires the correct choice of indications, necessitating precise knowledge of elementary arterial lesions. Arterial endoscopy appears to be more specific than angiography for this use, since it allows direct vision in vivo of the lesion, a histopathologic approach compared with the non univocal images produced by angiography (for example, an arterial obstruction can result from varied causes). Different accidents to the endothelial surface can be observed: golden yellow atheromatous elevations on a straw yellow background, intimal flaps, mobile intra-luminal vegetations. Established atheromatous stenosis are smooth and regular, or on the contrary ulcerated and edged with irregular flaps capable of provoking an eccentric residual lumen. The vegetating atheromatous lesions may project into the lumen, often as calcified and thus pearly white scales adhering to the wall, or as larger occlusive lesions. When capable of being isolated, a thrombus often completes the stenosis: its recognition is therefore fundamental since its removal exposes the subjacent lesions to be treated. The fresh clot is coral shaped, bright red and mobile in the blood flow. Established clots are compact and greenish brown. At an advanced stage of atheroma the surface of the occluding clot is covered with a regular straw yellow endothelium. In the presence of a dissecting vessel the fibroscope may be introduced into the false channel, no longer showing typical endothelium but a coagulated mass interspersed with fibrous bands. Prosthetic stenosis result from either intimal hyperplasia or a suturing fault with plication.
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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.
Esplugas, E; Alfonso, F; Alonso, J J; Asín, E; Elizaga, J; Iñiguez, A; Revuelta, J M
Interventional cardiology has had an extraordinary expansion in last years. This clinical guideline is a review of the scientific evidence of the techniques in relation to clinical and anatomic findings. The review includes: 1. Coronary arteriography. 2. Coronary balloon angioplasty. 3. Coronary stents. 4. Other techniques: directional atherectomy, rotational atherectomy, transluminal extraction atherectomy, cutting balloon, laser angioplasty and transmyocardial laser and endovascular radiotherapy. 5. Platelet glycoprotein IIb/IIIa inhibitors. 6. New diagnostic techniques: intravascular ultrasound, coronary angioscopy, Doppler and pressure wire. For the recommendations we have used the classification system: class I, IIa, IIb, III like in the guidelines of the American College of Cardiology and the American Heart Association.
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.
Jensen, Bjarke; Nielsen, Jan M; Axelsson, Michael; Pedersen, Michael; Löfman, Carl; Wang, Tobias
The multiple convergent evolution of high systemic blood pressure among terrestrial vertebrates has always been accompanied by lowered pulmonary pressure. In mammals, birds and crocodilians, this cardiac separation of pressures relies on the complete division of the right and left ventricles by a complete ventricular septum. However, the anatomy of the ventricle of most reptiles does not allow for complete anatomical division, but the hearts of pythons and varanid lizards can produce high systemic blood pressure while keeping the pulmonary blood pressure low. It is also known that these two groups of reptiles are characterised by low magnitudes of cardiac shunts. Little, however, is known about the mechanisms that allow for this pressure separation. Here we provide a description of cardiac structures and intracardiac events that have been revealed by ultrasonic measurements and angioscopy. Echocardiography revealed that the atrioventricular valves descend deep into the ventricle during ventricular filling and thereby greatly reduce the communication between the systemic (cavum arteriosum) and pulmonary (cavum pulmonale) ventricular chambers during diastole. Angioscopy and echocardiography showed how the two incomplete septa, the muscular ridge and the bulbuslamelle - ventricular structures common to all squamates - contract against each other in systole and provide functional division of the anatomically subdivided ventricle. Washout shunts are inevitable in the subdivided snake ventricle, but we show that the site of shunting, the cavum venosum, is very small throughout the cardiac cycle. It is concluded that the python ventricle is incapable of the pronounced and variable shunts of other snakes, because of its architecture and valvular mechanics.
Foucart, H; Carlier, C; Baudrillard, J C; Joffre, F; Cécile, J P
A study on the long-term efficacy of femoral-popliteal angioplasty was carried out on 185 angioplasty cases over a 5 year follow-up period. A classification of data according to the type of lesion treated, revealed that results were favorable in case of stenosis (87%), short obstruction (70%) and long obstruction (35%). A special study of the outcome of treatments for stage IV arteritis was carried out. After comparing results with those obtained by other teams, the authors list the complications encountered, hematomas, and thromboses, and show their current tendency for regression. Lastly, the authors stress the advantages of angioscopy, which permits to identify the nature of the treated lesions and to predict possible complications, which are usually underrated by angiography.
A. A. Komkov
Full Text Available Achievements of interventional cardiology in the treatment of coronary artery disease are based on coronary balloon angioplasty with implanting bare metal stents and drug eluting stents. Questions of complications such as early stent thrombosis and restenosis of stent were solved in a considerable degree. However, with the lengthening of the followup period, the problem of late complications became obvious. Except endothelization and fibromuscular proliferation in stented coronary arteries the process of plaque formation has an important influence on later complications in follow-up period more than one year. This process was defined as neoatherosclerosis. This is verified by clinical manifestations of the disease, histological studies, angioscopy, intravascular ultrasound and optical-coherence tomography in stented patients. Dynamic observation of the condition in stentedcoronary arteries showed multistep proliferation with restenosis, its regression, and neoatherosclerosis development. Evidences of neoatherosclerosis formation in stented coronary arteries are considered in this review.
何卫红; 陈伟; 周晖
目的 初步探讨双源CT冠状动脉成像时利用仿真内镜诊断冠状动脉疾病的潜在价值.方法 使用Fly-through软件对40例双源CT冠状动脉成像病例行仿真内镜观察,并与CT冠状动脉成像常规方法和传统冠状动脉造影术进行比较.结果 40例患者共120支冠状动脉中,92％(110/120)的冠状动脉可行仿真内镜成像；仿真内镜判断有意义的冠状动脉狭窄正确率为85％( 41/48)；常规CT冠状动脉成像不能判断的9处严重钙化,仿真内镜显示为显著或高度狭窄；4枚冠状动脉支架内和3支桥血管仿真内镜显示通畅.结论 仿真内镜可立体显示正常和病变冠状动脉腔内情况,是CT冠状动脉成像后处理方法的的重要补充.%[Objective] To explore the potential clinical value of virtual endoscopy in detecting coronary artery lesions. [Methods] Forty patients underwent dual-source CT coronary angiography. Virtual endoscopies were simulated in 120 coronary arteries using the Fly-through software, with routine imaging post-processing methods of CT coronary angiography and conventional coronary angiography as the reference standard. [Results] Virtual endo- scopies of 92% (110/120) major coronary artery were successfully performed with good image quality, and the accuracy of virtual coronary angioscopy was 85% (41/48) for detecting hemodynamically significant stenoses confirmed by conventional coronary angiography. Using virtual coronary angioscopy, 9 severe calcified coronary arteries were identified as significant or severe stenoses, while unable to estimate by routine CT coronary angiography. Virtual endoscopies of intracoronary stents (n=4) or bypass grafts (n=4) were patency. [Conclusions] Endoscopy of coronary arteries using dual-source CT allows comprehensive 3-dimensional delineation of the vessel lumen, and can be used as an important complement to the routine post-processing methods of CT coronary angiography in some cases.
Critical coronary stenoses have been shown to contribute to only a minority of acute coronary syndromes (ACS) and sudden cardiac death. Autopsy studies have identified a subgroup of high-risk patients with disrupted vulnerable plaque and modest stenosis. Consequently, a clinical need exists to develop methods to identify these plaques prospectively before disruption and clinical expression of disease. Recent advances in invasive and noninvasive imaging techniques have shown the potential to identify these high-risk plaques. The anatomical characteristics of the vulnerable plaque such as thin cap fibroatheroma and lipid pool can be identified with angioscopy, high frequency intravascular ultrasound, intravascular MRI, and optical coherence tomography. Efforts have also been made to recognize active inflammation in high-risk plaques using intravascular thermography. Plaque chemical composition by measuring electromagnetic radiation using spectroscopy is also an emerging technology to detect vulnerable plaques. Noninvasive imaging with MRI, CT, and PET also holds the potential to differentiate between low and high-risk plaques. However, at present none of these imaging modalities are able to detect vulnerable plaque neither has been shown to definitively predict outcome. Nevertheless in contrast, there has been a parallel development in the physiological assessment of advanced atherosclerotic coronary artery disease. Thus recent trials using fractional flow reserve in patients with modest non flow-limiting stenoses have shown that deferral of PCI with optimal medical therapy in these patients is superior to coronary intervention. Further trials are needed to provide more information regarding the natural history of high-risk but non flow-limiting plaque to establish patient-specific targeted therapy and to refine plaque stabilizing strategies in the future.
Full Text Available OBJECTIVES: Oxidized low-density lipoprotein (oxLDL plays a key role in the formation of atherosclerotic plaques. However, its localization in human coronary arterial wall is not well understood. The present study was performed to visualize deposition sites and patterns of native oxLDL and their relation to plaque morphology in human coronary artery. METHODS: Evans blue dye (EB elicits a violet fluorescence by excitation at 345-nm and emission at 420-nm, and a reddish-brown fluorescence by excitation at 470-nm and emission at 515-nm characteristic of oxLDL only. Therefore, native oxLDL in excised human coronary artery were investigated by color fluorescent microscopy (CFM using EB as a biomarker. RESULTS: (1 By luminal surface scan with CFM, the % incidence of oxLDL in 38 normal segments, 41 white plaques and 32 yellow plaques that were classified by conventional angioscopy, was respectively 26, 44 and 94, indicating significantly (p<0.05 higher incidence in the latter than the former two groups. Distribution pattern was classified as patchy, diffuse and web-like. Web-like pattern was observed only in yellow plaques with necrotic core. (2 By transected surface scan, oxLDL deposited within superficial layer in normal segments and diffusely within both superficial and deep layers in white and yellow plaques. In yellow plaques with necrotic core, oxLDL deposited not only in the marginal zone of the necrotic core but also in the fibrous cap. CONCLUSION: Taken into consideration of the well-known process of coronary plaque growth, the results suggest that oxLDL begins to deposit in human coronary artery wall before plaque formation and increasingly deposits with plaque growth, exhibiting different deposition sites and patterns depending on morphological changes.
The characteristics of vulnerable plaque are thin fibrous cap, high proportional atherosclerotic core, increased plaque inflammation, and intraplaque hemorrhage. Vulnerable plaques are apt to rupture,causing platelet adhesion, platelet aggregation, and thrombosis. Vulnerable plaque rupture within coronary artery may induce acute coronary events. Intravascular ultrasounds, virtual histology, palpography, optical coherence tomography, intravascular magnetic resonance imaging, angioscopy, and spectroscopy are currently methods for detecting vulnerable plaque. Drugs, regional therapy, and stents are main strategies for treating vulnerable plaque nowadays.%易损斑块的特征是纤维帽薄、动脉粥样硬化斑块核心比例高、斑块炎症明显及伴斑块内出血.易损斑块易发生破裂,引起血小板黏附聚集和血栓形成.冠状动脉内易损斑块破裂可引起急性冠脉事件.血管内超声、虚拟组织学成像、激应图成像、光学相干断层成像、血管内磁共振显像、血管镜、分光镜等是目前检测易损斑块的主要手段.对冠状动脉内易损斑块应积极干预,药物、局部治疗、安放支架等是目前治疗易损斑块的主要方法.
Indira Martínez Chavarría
Full Text Available The case of a male, white skin, 38 years old patient who came to the emergency department because of a severe respiratory distress is reported. The left patella fracture history was collected and an immobilization cast was implemented. The posterior to anterior chest X-ray showed opacities in the form of a veil at the base of the left hemithorax as well as increased cardiothoracic rates. A lung computed tomography angiography scan was performed using a SIEMENS SESATION 64 multislice computed tomography scanner. The study was rebuilt using volume rendering technique and 3D applications with virtual angioscopy. Thrombus occlusion was evident at the trunk of the left pulmonary artery and its branches. The patient was admitted for anticoagulation treatment. Patients with patellar fracture as a trigger for this serious condition involving life-risk had not been treated in this hospital, that is why it was decided to publish this case, as well as for the implementation of such an innovative, useful and quick diagnosis aided by multislice computed tomography angiography.Se presenta el caso de un paciente del sexo masculino, de color de piel blanca, de 38 años de edad que acudió al Servicio de Urgencias por padecer de dificultad respiratoria. Se recogió el antecedente de fractura a nivel de rótula izquierda e inmovilización con yeso. El rayos X del tórax en posición postero anterior mostró opacidades en forma de velo en la base del hemitórax izquierdo e índice cardiotorácico aumentado. Se realizó angiotomagrafía pulmonar en tomógrafo multicorte SIEMENS SESATION 64. Se reconstruyó el estudio con las aplicaciones VRT y 3D con angioscopia virtual. Se evidenció oclusión por trombo a nivel del tronco de la arteria pulmonar izquierda y sus ramas. Se ingresó para tratamiento de anticoagulación. Por no haber sido observado en este medio, en pacientes con fractura de rótula como factor desencadenante de esta afección grave que puede
张庆桥; 陈雪荣; 闵继忠; 祖茂衡; 徐浩; 顾玉明; 李国均; 魏宁; 许伟; 刘洪涛; 崔艳峰
originated from the site of IVC occlusions in 9 patients were detected by the 3D-DSA.However.the 2D-DSA provided excellent visualization of the vascular structures of the IVC in 7 patients.and the collateral vessels origihated from the site of IVC occlusions were shown in 2 patients.The 3D-DSA was significantly superior to the 2D-DSA in detecting the IVC obstructions and the collateral vessels(P＜0.05).The virtual angioscopy of the 3D-DSA was able to visualize free IVC thrombosis in 3 paitents.and mural IVC thrombosis in 1 patient.The procedures were successful in all patients.There were no other complications except the rupture of IVC in 1 patient.Conclusion The 3D-DSA can offer valuable informations in diagnosis of IVC obstruction.and it may play an important role in interventional treatment of Budd-Chiari syndrome.