Clinical significance of the presence of puff‐chandelier ruptures detected by nonobstructive aortic angioscopy

Yoshizumi, Masao; Yonetsu, Taishi; Hoshino, Masahiro; Sugiyama, Tomoyo; Kanaji, Yoshihisa; Ohya, Hiroaki; Hada, Masahiro; Sumino, Yohei; Kanno, Yoshinori; Hirano, Hirohiko; Jang, Ik–Kyung; Horie, Tomoki; Hamaya, Rikuta; Usui, Eisuke; Sugano, Akinori; Murai, Tadashi; Lee, Tetsumin; Kimura, Shigeki; Fujii, H.; Hikita, Hiroyuki; Kakuta, Tsunekazu

doi:10.1002/ccd.28574

Cited by 6 publications

(9 citation statements)

References 25 publications

(49 reference statements)

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“…Various types of plaques and injuries detected using NOGA have been reported in aorta [3][4][5][6][8][9][10][11][12][13][14][15] (Table 1). The terms of angioscopic findings are going to be standardized [16].…”

Section: Spontaneous Ruptured Aortic Plaques and Injuriesmentioning

confidence: 99%

“…Aortic plaques and injuries are incomparable to the findings of CTA [3]. In particular, puff rupture and puff-chandelier rupture are the blowing-out types, which may cause systemic embolization [6,15]. SRAPs may contain atheromatous materials, fibrin, macrophage, calcification, and their mixture.…”

Section: Spontaneous Ruptured Aortic Plaques and Injuriesmentioning

confidence: 99%

“…Puff rupture [4,6,8,16] White or white-yellow colored puff-like materials easily blown out spontaneously Chandelier rupture [4,6,8,16] Materials that glisten against the light from the tip of the fiber catheter of a non-obstructive general angioscopy, wriggling but not blown out Puff-chandelier rupture [4,6,8,15,16] Mixture of puff rupture and chandelier appearance Strawberry-Jam appearance [5,15,16] Red thrombi adhering in the surface of the aorta-like strawberry jam, not ulcerative, never washed out by infusion of low molecular dextran Cotton candy appearance [4,8,12,15,16] Solid white or red materials like a cotton candy, but not movable Erosion [4,15,16] Erosive lesion below the media of the aortic wall Intramural bleeding [4,10,13] Bleeding towards the lumen Fissure [3,4,13,15,16] Elongated cleft or tear Fissure bleeding [4,11] Blood flow from the fissure to the inside of the aorta Angioscopic ulcer [4,13,15,16] Angioscopically observed ulceration that penetrates the internal elastic lamina and the media of the aortic wall Flap [4,8,11,16] Piece of tissue, partially detached, whic...…”

Section: Sraps and Aortic Injuries Angioscopic Definitionmentioning

confidence: 99%

“…Assessing the correlation between cardiovascular events including stroke and SRAPs was tried in a multicenter retrospective trial [15]. The amounts of emboli might be correlated to white matter lesion or ischemic lesion.…”

Section: Strokementioning

confidence: 99%

“…NOGA may also indicate pathogenesis of acute "atherosclerotic" aortic syndrome (AAAS). Fissures that are a few millimeters in size and fissure bleeding [4,15] are commonly found in patients without apparent aortic dissection. Does initial medial disruption really extend antegrade or retrograde direction of aorta to develop aortic dissection?…”

Section: Coronary Artery Diseasementioning

confidence: 99%

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Spontaneous ruptured aortic plaque and injuries: insights for aging and acute aortic syndrome from non-obstructive general angioscopy

Komatsu

Takahashi

Yutani

et al. 2020

Journal of Cardiology

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Recent advances in non-obstructive general angioscopy (NOGA) have enabled the detection of aortic atherosclerosis. The incidence of spontaneous ruptured aortic plaques (SRAPs) and aortic injuries was found to be high in patients diagnosed with or suspected of having coronary artery disease. These facts may result in a paradigm shift for diseases such as aging and acute aortic syndrome because the incidence of systemic embolic diseases and aortic disease are assumed be high. Aortic thromboembolism has been thought to be mainly iatrogenic and is referred to as "cholesterol embolization syndrome" or "cholesterol crystal embolization", although the cholesterol crystals (CCs) were not demonstrated routinely as real images. Atheromatous materials, fibrins, calcifications, macrophages, and a mixture of such substances are released through a puff or puff-chandelier rupture. Among atheromatous materials, CCs can be easily detected clinically in sampled blood via polarized light microscopy. Atheromatous materials include rich CCs and free monolayers, and multilayer CCs are released when the atheromatous materials from vulnerable plaques break into pieces, such as in puff or puff-chandelier rupture. Released SRAPs seem to be asymptomatic; however, accumulation of SRAPs referred to as accumulated spontaneous asymptomatic plaques may cause aging through systemic "embolic" processes, such as mechanical obstruction and an inflammasome pathway. Unique findings in "atherosclerotic" acute aortic syndrome, such as a clear boundary between the dissected lesion and the normal lesion, fissure/fissure bleeding suggesting an entry or a reentry, and subintimal blood flow detected through NOGA are reported. Fissure/ fissure bleeding and subintimal blood flow may be the first or last triggers of "atherosclerotic" acute aortic syndrome. Pre-emptive diagnosis and risk stratification of acute "atherosclerotic" aortic dissection and feedback for endovascular therapy may be enabled through the use of NOGA in the future.

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