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Heart, Lung & Circulation Apr 2019Chronic thromboembolic pulmonary hypertension (CTEPH) is a progressive disorder with a poor prognosis. Recently, balloon pulmonary angioplasty (BPA) has been reported to...
BACKGROUND
Chronic thromboembolic pulmonary hypertension (CTEPH) is a progressive disorder with a poor prognosis. Recently, balloon pulmonary angioplasty (BPA) has been reported to be an effective treatment for inoperable patients with CTEPH. However, this catheter-based treatment has potentially life-threatening vascular complications. To improve the efficacy and safety of BPA, we assessed the morphological evaluation of organised thrombus and the vascular injury by BPA procedure.
METHODS
In this study, we assessed the morphology of organised thrombi and the vascular injury observed by angioscopy during BPA in 28 lesions from nine CTEPH patients.
RESULTS
Angioscopy visualised various forms of organised thrombi such as 'Mesh', 'Slit', 'Flap' and 'Mass' and allowed for a detailed evaluation of organised thrombus that was difficult to do by conventional contrast angiography. In addition, after balloon dilation for BPA, angioscopy revealed a haemorrhage due to a vessel wall injury caused by wiring and/or ballooning.
CONCLUSIONS
Assessment of organised thrombus and vascular injury by angioscopy might contribute to improving the treatment of the patients with CTEPH.
Topics: Angiography; Angioplasty, Balloon; Angioscopy; Chronic Disease; Humans; Hypertension, Pulmonary; Pulmonary Artery; Pulmonary Embolism; Pulmonary Wedge Pressure; Treatment Outcome; Ultrasonography, Interventional
PubMed: 30224170
DOI: 10.1016/j.hlc.2018.08.008 -
Circulation Journal : Official Journal... May 2023
Topics: Humans; Coronary Artery Disease; Angioscopy; Coronary Vessels; Coronary Angiography
PubMed: 36967132
DOI: 10.1253/circj.CJ-23-0042 -
Circulation Reports Nov 2021Drug-eluting stents (DESs) have been widely used for the treatment of acute coronary syndrome (ACS). However, there are few reports on early- and middle-phase arterial...
Drug-eluting stents (DESs) have been widely used for the treatment of acute coronary syndrome (ACS). However, there are few reports on early- and middle-phase arterial repair after DES implantation in ACS patients. Coronary angioscopy (CAS) findings covering the early and middle phases (mean [±SD] 4±1 and 10±2 months, respectively) of arterial healing after second- and later-generation DES placement between May 2009 and January 2020 were extracted from the Kansai Rosai Hospital Cardiovascular Center database. Neointimal coverage (NIC), yellow color intensity, and the incidence of thrombus adhesion were compared between ACS and chronic coronary syndrome (CCS) in the early (54 stents of 47 lesions, 38 ACS patients; 86 stents of 70 lesions, 52 CCS patients) and middle (179 stents of 154 lesions from 136 ACS patients; 459 stents of 374 lesions from 287 CCS patients) phases. In the early phase, NIC, the incidence of thrombus adhesion (ACS, 39.1%; CCS, 38.0%), and maximum yellow color grade were similar between the 2 groups. In the middle phase, although the maximum yellow color grade was significantly higher in the ACS group (P=0.013), NIC and the incidence of thrombus adhesion (ACS, 24.6%; CCS, 23.4%) were similar in the 2 groups. Arterial healing assessment with CAS showed that NIC and the incidence of thrombus adhesion after DES implantation were similar between ACS and CCS patients.
PubMed: 34805607
DOI: 10.1253/circrep.CR-21-0113 -
Journal of Endovascular Therapy : An... Oct 2018To demonstrate the feasibility and potential utility of high-resolution angioscopy during common endovascular interventions.
PURPOSE
To demonstrate the feasibility and potential utility of high-resolution angioscopy during common endovascular interventions.
METHODS
A 3.7-F scanning fiber angioscope was used in 6 Yorkshire pigs to image branch vessel selection, subintimal dissection, wire snaring, and stent placement. The angioscope was introduced in a coaxial fashion within a standard 6-F guide catheter. A clear field of view was provided using continuous heparinized saline flush through the outer guide catheter. The flush flow rate was manually adjusted to provide clear imaging depending on the diameter of the vessel and local blood flow conditions.
RESULTS
The scanning fiber angioscope was compatible with off-the-shelf catheters and devices commonly used in peripheral and aortic interventions. Video-rate, high-resolution images were obtained during all the interventions tested and provided information that was complementary to simultaneously acquired fluoroscopy. The scanning fiber angioscope was able to detect subintimal dissection and branch vessel stent coverage with higher resolution than fluoroscopy alone.
CONCLUSION
Endoluminal imaging with the scanning fiber angioscope is feasible with current endovascular devices and provides additional relevant information that cannot be assessed fluoroscopically. The scanning fiber angioscope represents a novel optical platform on which new endovascular techniques may be developed that will minimize radiation and contrast doses for patients.
Topics: Angioplasty, Balloon; Angioscopes; Angioscopy; Animals; Feasibility Studies; Female; Femoral Artery; Fiber Optic Technology; Fluoroscopy; Male; Proof of Concept Study; Radiography, Interventional; Stents; Sus scrofa
PubMed: 30122139
DOI: 10.1177/1526602818794663 -
Circulation Reports May 2021The Orsiro ultrathin-strut, biodegradable-polymer, sirolimus-eluting stent (O-SES) has specific characteristics regarding its components and has demonstrated comparable...
The Orsiro ultrathin-strut, biodegradable-polymer, sirolimus-eluting stent (O-SES) has specific characteristics regarding its components and has demonstrated comparable clinical outcomes compared with durable-polymer, drug-eluting stents (DES). However, arterial repair following deployment of the O-SES has not been elucidated to date. Using data from the Kansai Rosai Hospital database between November 2010 and September 2020, we analyzed coronary angioscopy (CAS) findings a mean (±SD) of 10±2 months after implantation of an O-SES, a durable-polymer everolimus-eluting stent (Xience; X-EES), or a biodegradable-polymer everolimus-eluting stent (Synergy; S-EES). Neointimal coverage (NIC), yellow color intensity of the stented segment, and the incidence of thrombus adhesion were compared between the O-SES (66 stents from 42 patients), X-EES (119 stents from 87 patients), and S-EES (132 stents from 88 patients). NIC was significantly thinner for the O-SES than S-EES (P<0.001), but was similar between the O-SES and X-EES (P=0.25). Yellow color intensity was significantly greater for the O-SES than X-EES (P<0.001), but similar between the O-SES and S-EES (P=0.51). The incidence of thrombus adhesions was similar in all 3 groups. O-SES and X-EES resulted in similar inhibition of NIC and both resulted in a thinner NIC than with S-EES. In addition, O-SES exhibited a similar degree of thrombus adhesion as the other DES, suggesting similar thrombogenicity.
PubMed: 34136706
DOI: 10.1253/circrep.CR-21-0053 -
International Heart Journal Sep 2022Catheter-directed intra-arterial thrombolysis (CDT) is useful for not only patients with acute limb ischemia but also those with chronic total occlusions (CTOs) of the...
Catheter-directed intra-arterial thrombolysis (CDT) is useful for not only patients with acute limb ischemia but also those with chronic total occlusions (CTOs) of the lower extremity arteries. However, it is difficult to determine whether CTO lesions have significant thrombi, which can be treated by CDT, or not in a clinical setting. Angioscopy can accurately detect thrombi. We investigated the clinical impact of angioscopy guided endovascular therapy following thrombolysis (AGET) for in-stent occlusions (ISOs) in iliac or femoropopliteal arteries.We performed AGET in 7 patients with ISOs whose occlusion duration was less than 1 year. We performed angioscopy to evaluate the area of the thrombi after a successful wire crossing of an ISO lesion. In addition, we performed biopsies of ISO lesions to confirm whether the angioscopic findings coincided with the histopathological findings at 20 sites. We selectively performed a continuous infusion of urokinase using a fountain infusion catheter for ISO lesions. The next day, we evaluated the lesion flow and performed intervention only at the plaque stenosis site if necessary.AGET could achieve TIMI 3 flow in all patients, and preserved a 1-year patency in 5 patients (71.4%). The angioscopic findings of thrombi and plaque perfectly coincided with the histopathological findings.In conclusion, this new endovascular therapy technique, AGET, was observed to be feasible and safe for iliac or femoropopliteal artery ISO lesions.
Topics: Angioscopy; Endovascular Procedures; Femoral Artery; Humans; Peripheral Arterial Disease; Retrospective Studies; Stents; Thrombosis; Treatment Outcome; Urokinase-Type Plasminogen Activator; Vascular Patency
PubMed: 36104233
DOI: 10.1536/ihj.22-115 -
Circulation Journal : Official Journal... Nov 2020The relationship between the characteristics of tissue protrusion detected by using optical coherence tomography (OCT) and the findings of coronary angioscopy (CAS)...
BACKGROUND
The relationship between the characteristics of tissue protrusion detected by using optical coherence tomography (OCT) and the findings of coronary angioscopy (CAS) immediately after stent implantation were evaluated.Methods and Results:A total of 186 patients (192 stents) underwent OCT before and after stenting and were observed by using CAS immediately after stenting and at the chronic phase. Patients were assigned to irregular protrusion, smooth protrusion, and disrupted fibrous tissue protrusion groups according to OCT findings. Serum high-sensitivity C-reactive protein (hs-CRP) levels were measured before and after stent implantation. The grade of yellow color (YC) and neointimal coverage (NC), and incidence of thrombus in the stented segment were evaluated by using CAS. After stent implantation, maximum YC grade (smooth, 0.64±0.80; disrupted fibrous tissue, 0.50±0.77; irregular, 1.50±1.09; P<0.0001), a prevalence of Max-YC grade of 2 or 3 (smooth, 17%; disrupted fibrous tissue, 17%; irregular, 50%; P<0.0001) and thrombus (smooth, 15%; disrupted fibrous tissue, 10%; irregular, 69%; P=0.0005), and elevated hs-CRP levels (smooth, 0.22±0.89; disrupted fibrous tissue, -0.05±0.29; irregular, 0.75±1.41; P=0.023) were significantly higher in irregular protrusion than in the other 2 groups. In the chronic phase, maximum- and minimum-NC grade and heterogeneity index, and thrombus did not differ significantly among the 3 groups.
CONCLUSIONS
Irregular protrusion was associated with atherosclerotic yellow plaque, incidence of thrombus, and vascular inflammation. The angioscopic findings in the chronic phase may endorse the clinical efficacy of second- and third-drug eluting stents, regardless of the tissue protrusion type.
Topics: Angioscopy; C-Reactive Protein; Coronary Angiography; Coronary Vessels; Humans; Neointima; Percutaneous Coronary Intervention; Plaque, Atherosclerotic; Stents; Thrombosis; Tomography, Optical Coherence
PubMed: 33055456
DOI: 10.1253/circj.CJ-20-0306 -
Stroke Feb 2023
Topics: Humans; Angioscopy; Neointima; Sirolimus; Intracranial Aneurysm; Stents
PubMed: 36621822
DOI: 10.1161/STROKEAHA.122.041912 -
AsiaIntervention Sep 2018Coronary angioscopy (CAS) is a robust imaging methodology for evaluation of vascular healing response after stenting. However, the procedure requires a guiding catheter...
AIMS
Coronary angioscopy (CAS) is a robust imaging methodology for evaluation of vascular healing response after stenting. However, the procedure requires a guiding catheter with a diameter of more than 6 Fr, which is rather invasive at follow-up angiography. Recently, coronary angioscopes of a smaller diameter have been able to pass through a 4 Fr guiding catheter. This study aimed to investigate the feasibility and safety of slender CAS observation using a 4 Fr guiding catheter.
METHODS AND RESULTS
Thirty-three consecutive patients who underwent follow-up angiography were evaluated. Following usual angiography via the radial artery, the stent segment was observed by non-occlusive CAS through a 4 Fr guiding catheter. Low molecular weight dextran-L (4 mL/sec) was flushed from a guiding catheter to replace coronary blood. The success rate, anatomical or procedural factors related to the success, and incidence of adverse events were examined. The success rate was 84.8% (n=28/33). The luminal diameter at the orifice of the target vessel was larger in the successful than in the failed group (4.03±0.61 mm vs. 3.39±0.61 mm, respectively; p=0.009). The presence of deep engagement of the guiding catheter into the target vessel was a key factor for sufficient observation (100% in the successful group vs. 0% in the failed group; p<0.0001). No adverse events, such as dissection or acute coronary syndrome, were reported.
CONCLUSIONS
The new method of CAS through a 4 Fr guiding catheter demonstrated high feasibility and safety. This less invasive observation via CAS may be useful for stent follow-up.
PubMed: 36483993
DOI: 10.4244/AIJ-D-18-00003 -
Journal of Neurointerventional Surgery Oct 2019Endovascular technological advances have revolutionized the field of neurovascular surgery and have become the mainstay of treatment for many cerebrovascular...
BACKGROUND
Endovascular technological advances have revolutionized the field of neurovascular surgery and have become the mainstay of treatment for many cerebrovascular pathologies. Digital subtraction angiography (DSA) is the 'gold standard' for visualization of the vasculature and deployment of endovascular devices. Nonetheless, with recent technological advances in optics, angioscopy has emerged as a potentially important adjunct to DSA. Angioscopy can offer direct visualization of the intracranial vasculature, and direct observation and inspection of device deployment. However, previous iterations of this technology have not been sufficiently miniaturized or practical for modern neurointerventional practice.
OBJECTIVE
To describe the evolution, development, and design of a microangioscope that offers both high-quality direct visualization and the miniaturization necessary to navigate in the small intracranial vessels and provide examples of its potential applications in the diagnosis and treatment of cerebrovascular pathologies using an in vivo porcine model.
METHODS
In this proof-of-concept study we introduce a novel microangioscope, designed from coherent fiber bundle technology. The microangioscope is smaller than any previously described angioscope, at 1.7 F, while maintaining high-resolution images. A porcine model is used to demonstrate the resolution of the images in vivo.
RESULTS
Video recordings of the microangioscope show the versatility of the camera mounted on different microcatheters and its ability to navigate external carotid artery branches. The microangioscope is also shown to be able to resolve the subtle differences between red and white thrombi in a porcine model.
CONCLUSION
A new microangioscope, based on miniaturized fiber optic technology, offers a potentially revolutionary way to visualize the intracranial vascular space.
Topics: Angiography, Digital Subtraction; Angioscopy; Animals; Equipment Design; Female; Fiber Optic Technology; Humans; Neuronavigation; Proof of Concept Study; Swine
PubMed: 30878951
DOI: 10.1136/neurintsurg-2018-014610