Coronary Paque Imaging by Coronary Angioscopy-Comparison with the Other Modalities-

Abstract

IntroductionFor more than decades, conventional invasive coronary angiography has been the gold standard for the diagnosis of coronary artery disease and clinical decision making for percutaneous coronary intervention (PCI) Coronary AngioscopyCoronary angioscopy enables direct visualization of internal surface of a vessel and provides the detail information of various plaque morphology or thrombus formation. 3,4) Coronary plaques are assessed based on the surface color and characteristics.Plaque color is classified as white, light yellow, yellow (medium yellow) or intensive yellow (dark yellow) 4,5) (Fig. 1A). Yellow plaques of higher color grade is strongly related with the positive remodeling, thrombus formation and thin-cap fibroatheroma (TCFA) and considered high-risk plaque, 5-8) whereas white plaques correlate fibrous plaque or pathological intimal thickening and is considered as stable plaque. 9) Coronary angioscopy also has the ability to visualize intraluminal thrombus for high sensitivity and specificity, 10) and angioscopic thrombus is classified as red, white or mixed thrombus 11) (Fig. 1B). Furthermore this modality allows evaluation of neointimal coverage (NIC) after stent implantation and NIC was classified into 3 or 4 grades 12,13) (Fig. 1C). In particular coronary angioscopy was the first imaging modality that enabled direct visualization of neoatherosclerosis after drug-eluting stent (DES) implantation. 14)Coronary Paque Imaging by Coronary Angioscopy Comparison with the Other ModalitiesHiroaki Watabe, MD, PhD, * Akira Sato, MD, and Kazutaka Aonuma, MD, PhD.Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, JapanThe recent improvement of technical aspects of multimodality coronary imaging allow not only assessment of the degree of vessel luminal narrowing but also evaluation of the plaque characteristics and the useful prognostic information and accurate risk stratification. Among them, coronary angioscopy is the coronary imaging modality that enables direct visualization of internal surface of a vessel. Moreover it provides the detail information of plaque morphology, thrombus formation and neointimal coverage (NIC) after stent implantation. A lot of previous studies have shown that coronary angioscopy enabled not only the detection of vulnerable plaque but also prediction of cardiovascular events and percutaneous coronary intervention related complications. In this review, we discuss the role of coronary angioscopy for coronary plaque imaging, including in a comparison with other currently available imaging modalities used to examine atherosclerotic plaque.Key words: coronary angioscopy, vulnerable plaque, coronary imaging NIC at 1 year after 2nd-generation DES implantation was more homogeneous with white and less thrombus than that after 1st-generation DES. 13) Another study showed in-stent yellow plaque at 1 year after DES implantation was associated with cardiovascular event. 15)According to the reports of histopathologic validation of coronary angios...

Optical imaging techniques for vulnerable plaque detection

“…Angioscopy can be employed to visualise the inner parts of the blood vessels to identify the plaque and embolism [10]. This technique can also be used as an adjunctive procedure during the process of bypassing the vascular systems to visualise the valves within the veins system.…”