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Clinical Case Reports Oct 2023Contrast defects in veins are often diagnosed as benign thrombi, but depending on the patient's background it is necessary to differentiate between tumor thrombi. It is...
KEY CLINICAL MESSAGE
Contrast defects in veins are often diagnosed as benign thrombi, but depending on the patient's background it is necessary to differentiate between tumor thrombi. It is difficult to differentiate between these using contrast-enhanced CT alone, but with angioscopy it is easy to visually distinguish between a benign and tumor thrombi.
ABSTRACT
Contrast-enhanced computer tomography (CT) performed on a male patient being treated for de-differentiated chondrosarcoma revealed contrast defects in the pulmonary artery and right femoral vein, and a diagnosis of pulmonary artery thromboembolism and venous thromboembolism was made, and oral anticoagulant therapy was started. However, a follow-up CT showed that the contrast defect had extended to the inferior vena cava. Observation using an angioscope revealed that it was not a benign thrombi but a tumor.
PubMed: 37780915
DOI: 10.1002/ccr3.7975 -
Annals of Cardiothoracic Surgery Nov 2021
PubMed: 34926185
DOI: 10.21037/acs-2021-taes-21 -
AJNR. American Journal of Neuroradiology Jan 2021Visualization in neuroendovascular intervention currently relies on biplanar fluoroscopy and contrast administration. With the advent of endoscopy, direct visualization...
BACKGROUND AND PURPOSE
Visualization in neuroendovascular intervention currently relies on biplanar fluoroscopy and contrast administration. With the advent of endoscopy, direct visualization of the intracranial intravascular space has become possible with microangioscopes. We analyzed the efficacy of our novel microangioscope to enable direct observation and inspection of the cerebrovasculature, complementary to a standard fluoroscopic technique.
MATERIALS AND METHODS
Iterations of microangioscopes were systematically evaluated for use in neurodiagnostics and neurointerventions in both live animal and human cadaveric models. Imaging quality, trackability, and navigability were assessed. Diagnostic procedures assessed included clot identification and differentiation, plaque identification, inspection for vessel wall injury, and assessment of stent apposition. Interventions performed included angioscope-assisted stent-retriever thrombectomy, clot aspiration, and coil embolization.
RESULTS
The microangioscope was found helpful in both diagnosis and interventions by independent evaluators. Mean ratings of the imaging quality on a 5-point scale ranged from 3.0 (clot identification) to 4.7 (Pipeline follow-up). Mean ratings for clinical utility ranged from 3.0 (aspiration thrombectomy) to 4.7 (aneurysm treatment by coil embolization and WEB device).
CONCLUSIONS
This fiber optic microangioscope can safely navigate and visualize the intravascular space in human cadaveric and in vivo animal models with satisfactory resolution. It has potential value in diagnostic and neurointerventional applications.
Topics: Angioscopes; Angioscopy; Animals; Embolization, Therapeutic; Endovascular Procedures; Fluoroscopy; Humans; Intracranial Aneurysm; Neuroendoscopy; Rabbits; Swine
PubMed: 33361372
DOI: 10.3174/ajnr.A6900 -
World Journal of Diabetes Feb 2015Diabetes mellitus is a powerful risk factor of coronary artery disease (CAD), leading to death and disability. In recent years, given the accumulating evidence that... (Review)
Review
Diabetes mellitus is a powerful risk factor of coronary artery disease (CAD), leading to death and disability. In recent years, given the accumulating evidence that prediabetes is also related to increasing risk of CAD including cardiovascular events, a new guideline has been proposed for the treatment of blood cholesterol for primary prevention of cardiovascular events. This guideline recommends aggressive lipid-lowering statin therapy for primary prevention in diabetes and other patients. The ultimate goal of patient management is to inhibit progression of systemic atherosclerosis and prevent fatal cardiovascular events such as acute coronary syndrome (ACS). Because disruption of atherosclerotic coronary plaques is a trigger of ACS, the high-risk atheroma is called a vulnerable plaque. Several types of novel diagnostic imaging technologies have been developed for identifying the characteristics of coronary atherosclerosis before the onset of ACS, especially vulnerable plaques. According to coronary angioscopic evaluation, atherosclerosis severity and plaque vulnerability were more advanced in prediabetic than in nondiabetic patients and comparable to that in diabetic patients. In addition, pharmacological intervention by statin therapy changed plaque color and complexity, and the dynamic changes in plaque features are considered plaque stabilization. In this article, we review the findings of atherosclerosis in prediabetes, detected by intravascular imaging modalities, and the therapeutic implications.
PubMed: 25685289
DOI: 10.4239/wjd.v6.i1.184 -
Frontiers in Surgery 2022Atherosclerotic extracranial carotid artery stenosis accounts for about 20%-30% of all strokes, which is one of the leading causes of adult morbidity and mortality....
INTRODUCTION
Atherosclerotic extracranial carotid artery stenosis accounts for about 20%-30% of all strokes, which is one of the leading causes of adult morbidity and mortality. Although carotid endarterectomy (CEA) is still the mainly operational manner for atherosclerotic carotid artery stenosis/occlusion (ACAS/ACAO), and carotid angioplasty and stenting (CAS) have been used as an alternative, both CEA and CAS have limitations of their own, such as extensive invasiveness and in-stent restenosis.
METHODS
In this study we established a novel interventional system to take advantage of both CEA and CAS. Twenty consecutive carotid atherosclerotic plaques were harvested from the patients who underwent CEA. The plaques were randomized into two groups and inserted into the pruned and sutured descending aortas of the swine . The ZebraScope™ was modified with a protective device on its flexible tip, so that the plaque could be dissected from the wall of parent carotid artery and ablated completely without damage to the carotid artery. The holmium:YAG (Ho:YAG) and thulium fiber laser (TFL) generators were alternately used when needed.
RESULTS
All the carotid atherosclerotic plaques were completely ablated by Ho:YAG laser and/or TFL. The Ho:YAG laser was more effective for the atherosclerotic plaques with severe calcification, while the TFL was more suitable for those with moderate calcification. There were still some thermal injury spots on the inner wall of the parent carotid artery caused by the laser in the non-protected group B. In the protected group A, on the contrary, there was no even a thermal injury spot was found on the relevant location except for one sample. The difference of ablating duration was statistically significant between group A (36.5 ± 4.79 min) and group B (63.4 ± 6.55 min) ( < 0.01).
CONCLUSION
According to our knowledge, this is the first attempt to ablate carotid atherosclerotic plaques assisted by the ZebraScope™ . The protective and dissecting device on the tip of the angioscope makes it safe and visible when the ablation is performed to carotid atherosclerotic plaques. The Ho:YAG laser and TFL are effective and safe for ablating the plaque .
PubMed: 36299568
DOI: 10.3389/fsurg.2022.937492 -
Circulation Journal : Official Journal... Jul 2021
Topics: Angioscopy; Humans; Plaque, Atherosclerotic
PubMed: 34039837
DOI: 10.1253/circj.CJ-21-0102 -
Journal of the American College of... Jun 2018Spontaneous ruptured aortic plaques (SRAP), which might cause atheromatous embolization, are thought to be mainly iatrogenic and have not been observed directly.
BACKGROUND
Spontaneous ruptured aortic plaques (SRAP), which might cause atheromatous embolization, are thought to be mainly iatrogenic and have not been observed directly.
OBJECTIVES
The purpose of this study was to clarify the incidence, types, and dimensions of SRAP using angioscopy.
METHODS
In a cross-sectional study, 324 consecutive patients diagnosed with or suspected of having coronary artery disease were subjected to intra-aortic scans with nonobstructive angioscopy. Samples of SRAP were taken from the aorta. The dimensions of cholesterol crystals of atheromatous materials were measured with a polarizing microscope and compared with those of the ghost images of cholesterol crystals.
RESULTS
SRAP were detected in 262 patients (80.9%); 120 of 262 patients had ruptured aortic plaques below the diaphragmatic level. Samples were successfully obtained from 96 patients. The detected numbers of atheromatous material, fibrin, macrophage, and calcification were 237 (49.1%), 244 (50.6%), 111 (23.0%), and 127 (26.3%) out of 482 samples, respectively. The median lengths and widths of the sampled plaques were 254 μm (interquartile range [IQR]: 100 to 685 μm) and 148 μm (IQR: 535 to 423.5 μm), respectively. The lengths and widths of the cholesterol crystals isolated from atheromatous materials were 40 μm (IQR: 32.7 to 53.7 μm), and 30 μm (IQR: 23 to 38 μm), respectively, compared with the respective dimensions of the ghost images of 86 μm (IQR: 53 to 119) and 13 μm (IQR: 7 to 18 μm). No embolic symptoms were observed within 24 h of general care via cardiac catheterization.
CONCLUSIONS
SRAP are commonly scattered, and their dimensions were smaller than previously recognized. (Detecting Ruptured Aortic Plaques by Nonobstructive Angioscopy; UMIN000029772).
Topics: Aged; Aged, 80 and over; Angioscopy; Aorta; Aortic Diseases; Cholesterol; Cross-Sectional Studies; Female; Humans; Incidence; Japan; Male; Middle Aged; Plaque, Atherosclerotic; Rupture, Spontaneous
PubMed: 29929612
DOI: 10.1016/j.jacc.2018.03.539 -
Surgical Neurology International 2022A neuroendoscope is a technical advance that allows surgeons to visualize certain regions of the brain that was previously inaccessible through the use of a surgical...
BACKGROUND
A neuroendoscope is a technical advance that allows surgeons to visualize certain regions of the brain that was previously inaccessible through the use of a surgical microscope. Several neuroendoscope designs have been implemented by other neurosurgeons over the past 5 years. The advantage of a neuroendoscope is the addition of a flexible and narrow tip that allows for safe entry into intracranial structures for clinical observation. However, there are some limitations to this approach. Here, we report the use of a modified angioscope as a newly developed neuroendoscope to be employed in observing intracranial structures.
METHODS
We report the use of an angioscope that is 1.8 mm in diameter and has both a thin and flexible tip. In this study, the angioscope was inserted into the lumen of an aspirator tube, and the tip of the device was placed at the intracranial area of intended observation area. Image findings were evaluated using an established goat brain model.
RESULTS
The angioscope was light in weight and maneuverable and could be reached and observed in the blind spot using a surgical microscope. From the cerebellopontine angle, the lower cranial nerves and trigeminal nerve could be observed, and from the cisterna magna, the floor of the fourth ventricle and the aqueduct could be seen.
CONCLUSION
The angioscope is a useful instrument to observe intracranial locations safely and effectively even within a limited surgical field. Further modifications will be required to use the angioscope in various craniotomy procedures.
PubMed: 36324912
DOI: 10.25259/SNI_748_2022 -
Circulation Journal : Official Journal... Aug 2016
Comparative Study
Angioscopic Assessment of Stent Stability and Neointimal Coverage After Implantation of 2nd-Generation Drug-Eluting Stents - Comparison With Bare-Mental Stents and 1st-Generation Drug-Eluting Stents.
Topics: Angioscopy; Drug-Eluting Stents; Humans; Neointima
PubMed: 27488284
DOI: 10.1253/circj.CJ-16-0743 -
Open Heart May 2020Coronary angioscopy (CAS) is a useful modality to assess atherosclerotic changes, but interpretation of the images requires expert knowledge. Deep convolutional neural...
BACKGROUND
Coronary angioscopy (CAS) is a useful modality to assess atherosclerotic changes, but interpretation of the images requires expert knowledge. Deep convolutional neural networks (DCNN) can be used for diagnostic prediction and image synthesis.
METHODS
107 images from 47 patients, who underwent CAS in our hospital between 2014 and 2017, and 864 images, selected from 142 MEDLINE-indexed articles published between 2000 and 2019, were analysed. First, we developed a prediction model for the angioscopic findings. Next, we made a generative adversarial networks (GAN) model to simulate the CAS images. Finally, we tried to control the output images according to the angioscopic findings with conditional GAN architecture.
RESULTS
For both yellow colour (YC) grade and neointimal coverage (NC) grade, we could observe strong correlations between the true grades and the predicted values (YC grade, average r=0.80±0.02, p<0.001; NC grade, average r=0.73±0.02, p<0.001). The binary classification model for the red thrombus yielded 0.71±0.03 F-score and the area under the receiver operator characteristic curve was 0.91±0.02. The standard GAN model could generate realistic CAS images (average Inception score=3.57±0.06). GAN-based data augmentation improved the performance of the prediction models. In the conditional GAN model, there were significant correlations between given values and the expert's diagnosis in YC grade but not in NC grade.
CONCLUSION
DCNN is useful in both predictive and generative modelling that can help develop the diagnostic support system for CAS.
Topics: Angioscopy; Coronary Artery Disease; Coronary Vessels; Deep Learning; Humans; Image Interpretation, Computer-Assisted; Predictive Value of Tests; Prognosis; Reproducibility of Results
PubMed: 32404485
DOI: 10.1136/openhrt-2019-001177