Recent advances in coronary angioscopy

Uchida, Yasumi

doi:10.1016/j.jjcc.2010.11.001

Cited by 27 publications

(18 citation statements)

References 41 publications

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“…To address these issues, direct endoluminal optical visualization or angioscopy has been proposed as an adjuvant imaging modality since the 1980s1 and has been used to visualize the human aorta,2,3 coronary4 and peripheral5 arteries, as well as therapies such as carotid6 and coronary7 angioplasty. Angioscopy has also been used to observe the placement of intravascular occlusion coils and stents in the carotid arteries of porcine and canine animal models,8 as well as to assess the completeness of clip occlusion in a canine aneurysm model 9.…”

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confidence: 99%

High-Resolution Angioscopic Imaging During Endovascular Neurosurgery

et al. 2014

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High-Resolution Angioscopic Imaging During Endovascular Neurosurgery

et al. 2014

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“…There are only a few reports of human pathologic specimens of CTO in the literature. 1 Angioscopy has been reported to be useful for the direct visualization of thrombus and allows for characterization of the vessel wall from inside, 2 but we cannot observe the distal side of CTO in coronary arteries. Here we report an evaluation of the distal side of CTO of the superficial femoral artery (SFA) via a retrograde approach with angioscopy.…”

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confidence: 81%

Backyards of Chronic Total Occlusion

et al. 2014

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C hronic total occlusion (CTO) remains a challenging lesion subset in percutaneous coronary intervention and endovascular treatment because of low initial procedural success rates and high rates of restenosis at the chronic stage. There are only a few reports of human pathologic specimens of CTO in the literature.1 Angioscopy has been reported to be useful for the direct visualization of thrombus and allows for characterization of the vessel wall from inside, 2 but we cannot observe the distal side of CTO in coronary arteries. Here we report an evaluation of the distal side of CTO of the superficial femoral artery (SFA) via a retrograde approach with angioscopy. Case 1A 71-year-old man with hypertension, dyslipidemia, and type 2 diabetes mellitus noticed intermittent claudication in both legs in 2003. He received endovascular treatment of the left iliac artery in 2003 and that of the right iliac artery in 2008. The symptom, however, recurred in 2010, and medical treatment failed to improve it. He received another endovascular treatment for the right SFA. Control angiography revealed a short total occlusion in the right SFA ( Figure 1A and Movies I and II in the online-only Data Supplement). We decided to approach the CTO both antegradely and retrogradely according to the previous report.3 Under an adequate anticoagulation with heparin, we observed proximal and distal sides of CTO of the SFA with angioscopy. It showed the presence of white, red, and mixed thrombi over the light yellow plaques ( Figure 1B through 1D and Movies III through V in the onlineonly Data Supplement) on the distal side of the CTO, but there was no thrombus on the proximal side. After the angioscopic examination, we implanted stents, and the angiography thereafter showed no sign of thromboembolism. Case 2A 76-year-old woman with hypertension, dyslipidemia, and chronic atrial fibrillation noticed intermittent claudication in both legs after a 100-meter walk in 2008. Medical treatment was started without effect, leaving progression of the leg pain after a 40-meter walk. A diagnostic angiography revealed a long total occlusion of the left SFA (Figure 2A and Movie VI in the online-only Data Supplement) in January 2013. One month later, an angioscopic examination was performed as described above before conducting endovascular treatment for the lesion. It showed the presence of white and red thrombi over the dark yellow plaques ( Figure 2B and 2C and Movies VII and VIII in the online-only Data Supplement) on the distal side of the CTO, whereas it showed no thrombus in the proximal side. We implanted stents in the lesion, and the postprocedural angiography showed no sign of thromboembolism. DiscussionThe histopathologic process of CTO formation has not been well understood. It is generally considered that CTO starts with occlusion of the artery with thrombus, followed by replacement with collagen formation and deposition of calcium. 4 Although this theory is widely believed, it is difficult to prove in vivo, and the previous histologic study repor...

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“…Plaque color is classified as white, light yellow, yellow (medium yellow) or intensive yellow (dark yellow) 4,5) (Fig. 1A).…”

Section: Coronary Angioscopymentioning

confidence: 99%

“…Moreover it provides the detail information of plaque morphology or thrombus formation. 3,4) 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.…”

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

2017

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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...

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Recent advances in coronary angioscopy

Cited by 27 publications

References 41 publications

High-Resolution Angioscopic Imaging During Endovascular Neurosurgery

High-Resolution Angioscopic Imaging During Endovascular Neurosurgery

Backyards of Chronic Total Occlusion

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

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