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Journal of Vascular and Interventional... Feb 2022To determine the correlation between upstream atherosclerosis in the femoropopliteal arteries, assessed using angioscopy, and impaired infrapopliteal runoff.
PURPOSE
To determine the correlation between upstream atherosclerosis in the femoropopliteal arteries, assessed using angioscopy, and impaired infrapopliteal runoff.
MATERIALS AND METHODS
Thirty-one patients with peripheral arterial disease who underwent endovascular therapy and angioscopy were prospectively included. Yellow plaque color scores were semiquantitatively determined as 0, 1, 2, or 3. Irregular plaques with rough surfaces, similar to gastric ulcers, were defined as ulcerated plaques (UPs). Angioscopic data were correlated with angiographic runoff scores (ARS).
RESULTS
UPs were detected in 74.2% of enrolled diseased legs using angioscopy. Mural thrombi were more commonly observed in the femoropopliteal artery in patients with UPs than in those without UPs (91.3% vs 37.5%, respectively; P = .006) and were frequently found on the UPs (21/23 patients with UPs). Univariate and multivariate linear regression analyses revealed that the presence of UPs was positively and independently associated with a poor ARS and that oral anticoagulant use was independently associated with a preferable ARS (standardized β = 0.462, P = .004 and standardized β = -0.411, P = .009, respectively, in the multivariate analysis).
CONCLUSIONS
UPs, associated with mural thrombi and diagnosed by angioscopic examination, were demonstrated to be one of the factors associated with poor infrapopliteal runoff.
Topics: Angioscopy; Atherosclerosis; Coronary Vessels; Humans; Risk Factors; Thrombosis
PubMed: 34715323
DOI: 10.1016/j.jvir.2021.10.013 -
Journal of Biomedical Optics Sep 2023The scanning fiber endoscope (SFE), an ultrasmall optical imaging device with a large field-of-view (FOV) for having a clear forward view into the interior of blood...
SIGNIFICANCE
The scanning fiber endoscope (SFE), an ultrasmall optical imaging device with a large field-of-view (FOV) for having a clear forward view into the interior of blood vessels, has great potential in the cardiovascular disease diagnosis and surgery assistance, which is one of the key applications for short-wave infrared biomedical imaging. The state-of-the-art SFE system uses a miniaturized refractive spherical lens doublet for beam projection. A metalens is a promising alternative that can be made much thinner and has fewer off-axis aberrations than its refractive counterpart.
AIM
We demonstrate a transmissive metalens working at 1310 nm for a forward viewing endoscope to achieve a shorter device length and better resolution at large field angles.
APPROACH
We optimize the metalens of the SFE system using Zemax, fabricate it using e-beam lithography, characterize its optical performances, and compare them with the simulations.
RESULTS
The SFE system has a resolution of at the center of field (imaging distance 15 mm), an FOV of , and a depth-of-focus of , which are comparable with a state-of-the-art refractive lens SFE. The use of the metalens reduces the length of the optical track from 1.2 to 0.86 mm. The resolution of our metalens-based SFE drops by less than a factor of 2 at the edge of the FOV, whereas the refractive lens counterpart has a times resolution degradation.
CONCLUSIONS
These results show the promise of integrating a metalens into an endoscope for device minimization and optical performance improvement.
Topics: Endoscopy, Gastrointestinal; Radionuclide Imaging; Refraction, Ocular; Lens, Crystalline; Lenses
PubMed: 36911164
DOI: 10.1117/1.JBO.28.9.094802 -
Journal of Endovascular Therapy : An... Apr 2023Despite the increase in the number of patients with peripheral artery disease (PAD), the pathophysiology is not fully elucidated. Recently, angioscopy with a...
BACKGROUND
Despite the increase in the number of patients with peripheral artery disease (PAD), the pathophysiology is not fully elucidated. Recently, angioscopy with a 0.48-megapixel equivalent resolution camera became available for patients with PAD. We aimed to compare the plaque component between native stenosis and occlusion in the femoropopliteal artery using this modality.
MATERIALS AND METHODS
Thirty-two consecutive patients who underwent endovascular treatment for native femoropopliteal artery disease with angioscopy were studied. The major angioscopic classifications of each lesion were defined as follows: atheromatous plaque (AP) was defined as luminal narrowing without any protrusion, calcified nodule (CN) was defined as a protruding bump with surface irregularity, a mainly reddish thrombus was defined as organizing thrombus (OG), and organized thrombus (OD) was defined by more than half of the thrombus showing a whitish intima-like appearance.
RESULTS
A total of 34 lesions (stenosis, n=18; occlusion, n=16) from 32 patients were included. All stenotic lesions showed AP or CN (n=8 [44%], n=10 [56%], respectively), whereas all occluded lesions showed OG or OD (n=5 [31%], n=11 [69%], respectively), which amounted to a statistically significant difference (p<0.001). In occluded lesions, stiff wires (>3 g) were required to cross all lesions classified as OD, whereas this was not always necessary for lesions classified as OG (11 [100%] of 11, 1 [25%] of 5, respectively; p=0.04). Yellow color plaques were observed to a similar degree in all angioscopic classifications. Major adverse limb events, defined as amputation and any reintervention at 12 months, were highly variable, depending on the angioscopic findings, and tended to be more frequently observed in CN and OD (13% in AP, 40% in CN, 0% in OT, and 36% in OD, p=0.25).
CONCLUSION
Angioscopy revealed varying components in stenosis and occlusion with different degrees of clinical impact. This may provide new information on the pathophysiology of PAD.
Topics: Humans; Angioscopy; Constriction, Pathologic; Treatment Outcome; Femoral Artery; Thrombosis; Plaque, Atherosclerotic; Peripheral Arterial Disease; Coronary Vessels
PubMed: 35179063
DOI: 10.1177/15266028221079759 -
Journal of Cardiology Jul 2022The plaques with higher grade of yellow color by angioscopy are reported to be associated with vulnerability leading to adverse outcomes in coronary artery diseases....
BACKGROUND
The plaques with higher grade of yellow color by angioscopy are reported to be associated with vulnerability leading to adverse outcomes in coronary artery diseases. However, no studies have been performed for peripheral artery disease (PAD). We aimed to evaluate the relationship of angioscopic findings of peripheral arteries with the long-term prognosis.
METHODS
Angioscopy of iliac or femoropopliteal artery was performed before endovascular therapy in patients with PAD. The local plaque color and presence of thrombus were evaluated. Multivariable Cox regression models were used to estimate hazard ratio (HR) for all-cause mortality or major adverse cardiovascular event (MACE) related to the plaque colors as well as presence of thrombus.
RESULTS
Among 67 patients, 49.3% had intensive yellow plaques (group H) and the rest had light yellow to yellow ones (group L). Thrombus was detected in 74.6% of the patients and the presence was not different between the two groups. In Kaplan-Meier analysis during a median follow-up of 976 days and 757 days, group H showed increased mortality and MACE compared with group L (p <0.01 for both). Multivariable analysis demonstrated that the intensive yellow color of plaque was independently associated with mortality and MACE [HR: 11.48, 95% confidence interval (CI): 2.19-211.1 and HR: 3.81, 95% CI: 1.36-13.48, respectively] after adjusting for the presence of thrombus.
CONCLUSIONS
The yellow color intensity in local plaques by angioscopy may be a novel predictor of long-term prognosis in patients with PAD, regardless of the presence of thrombus.
Topics: Angioscopy; Coronary Artery Disease; Coronary Vessels; Humans; Peripheral Arterial Disease; Plaque, Atherosclerotic; Prognosis
PubMed: 35219551
DOI: 10.1016/j.jjcc.2022.02.004 -
Cureus Jan 2024Background Cholesterol crystals (CCs) are related to innate inflammation in spontaneously ruptured aortic plaques (SRAPs), and variability exists in the CCs and...
Background Cholesterol crystals (CCs) are related to innate inflammation in spontaneously ruptured aortic plaques (SRAPs), and variability exists in the CCs and interleukin (IL)-6 ratio in SRAPs. Methods The prevalence of scattering-type ruptures that glittered against the light of angioscopic fibers (puff-chandelier ruptures) and those that did not (puff ruptures) was analyzed in 848 patients with suspected coronary artery disease. Overall, 177 puff-chandelier ruptures and 105 puff ruptures were sampled using nonobstructive general angioscopy (NOGA). The sampled plaques were analyzed by direct detection of CCs with polarized light microscopy. The characteristics of the plaque fragments from puff and puff-chandelier ruptures were compared. The Interleukin-6 (IL-6) ratios were calculated for 100 puff-chandelier ruptures and 100 puff ruptures. Results CCs were detected in 54% of puff-chandelier ruptures and 20% of puff ruptures. The longer and shorter dimensions of the puff ruptures were smaller than those of the puff-chandelier ruptures. CCs were more prevalent in puff chandeliers than in puff ruptures (54% vs. 20%, respectively; p<0.0001). The number of CCs was higher in puff chandeliers than in puff ruptures with CCs (median 12,727 (interquartile range (IQR) 3,636-25,909)/10 mL vs. median 3,182 ( IQR 909-9,318)/10 mL) in CC-positive samples (p=0.0120). The IL-6 ratio of puff-chandelier ruptures was higher than that of puff ruptures (p=0.0014). Conclusions Examination of plaque fragments from puff-chandelier and puff ruptures revealed a higher prevalence of CCs in puff-chandelier ruptures compared to puff ruptures. Puff chandeliers exhibited a significantly greater number of CCs, suggesting a potential correlation with inflammatory levels. The IL-6 ratio was also higher in puff-chandelier ruptures. Direct detection of CCs and hematoxylin and eosin staining for SRAPs demonstrated variations in CC degree and dimensions between puff-chandelier and puff ruptures. Puff-chandelier ruptures exhibited more CCs associated with innate inflammation and larger fragments than puff ruptures. NOGA proved effective in detecting diverse characteristics and inflammation levels, as indicated by IL-6, in scattering-type SRAPs.
PubMed: 38274622
DOI: 10.7759/cureus.52949 -
Journal of the American Heart... Sep 2021Background Current guidelines recommend at least 6 months of antithrombotic therapy and antibiotic prophylaxis after septal-occluding device deployment in transcatheter...
Background Current guidelines recommend at least 6 months of antithrombotic therapy and antibiotic prophylaxis after septal-occluding device deployment in transcatheter closure of atrial septal defect. It has been estimated that it takes ≈6 months for complete neo-endothelialization; however, neo-endothelialization has not previously been assessed in vivo in humans. Methods and Results The neointimal coverage of septal occluder devices was evaluated 6 months after implantation in 15 patients by angioscopy from the right atrium. Each occluder surface was divided into 9 areas; the levels of endothelialization in each area were semiquantitatively assessed by 4-point grades. Device neo-endothelialization was sufficient in two thirds of patients, but insufficient in one third. In the comparison between patients with sufficiently endothelialized devices of average grade score ≥2 (good endothelialization group, n=10) and those with poorly endothelialized devices of average grade score <2 (poor endothelialization group, n=5), those in the poor endothelialization group had larger devices deployed (27.0 mm [25.0-31.5 mm] versus 17.0 mm [15.6-22.5 mm], respectively) and progressive right heart dilatation. The endothelialization was poorer around the central areas. Moreover, the prevalence of thrombus formation on the devices was higher in the poorly endothelialized areas than in the sufficiently endothelialized areas (Grade 0, 94.1%; Grade 1, 63.2%; Grade 2, 0%; Grade 3, 1.6%). Conclusions Neo-endothelialization on the closure devices varied 6 months after implantation. Notably, poor endothelialization and thrombus attachment were observed around the central areas and on the larger devices.
Topics: Angioscopy; Heart Septal Defects, Atrial; Humans
PubMed: 34533044
DOI: 10.1161/JAHA.120.019282 -
Journal of Cardiology May 2021Detection of the early stage of atherosclerosis, which does not exhibit macroscopic morphological changes, is currently beyond the scope of any available imaging...
BACKGROUND
Detection of the early stage of atherosclerosis, which does not exhibit macroscopic morphological changes, is currently beyond the scope of any available imaging techniques. Collagens provide mechanical support of vascular wall and subtype I is the major component of the normal vascular wall. During the process of atherosclerosis, collagen III appears first, followed by subtypes IV and V during fibrosis of the intima. Therefore, the presence of collagen III indicates initiation of atherosclerosis. Here, we aimed to visualize collagen subtypes in human coronary wall.
METHODS
Under microscopy, collagen III was stained emerald-green, collagen I was red, and IV and V were pink in the presence of a mixture of Silius red and Fast green dyes. Fifty-one coronary arteries excised from 20 human autopsy subjects were classified by angioscopy and histology as normal segments, white and yellow plaques, and examined after staining collagen subtypes in their superficial layer with the same dye mixtures.
RESULTS
Normal coronary segments with intimal thickness ≦200 μm stained red, with thickness >200 μm stained red and emerald-green in a mosaic pattern or emerald-green alone, yellow plaques without a necrotic core were pink, and those with a necrotic core showed no staining.
CONCLUSION
The results suggested that coronary segments stained red indicate no atherosclerosis, red and emerald-green in a mosaic pattern indicates initiation of atherosclerosis, emerald-green is early-stage atherosclerosis, pink is advanced stage of atherosclerosis, and no staining shows the end stage of atherosclerosis at least in superficial layer of coronary artery. Therefore, dye-staining angioscopy using Silius red and Fast green dyes in combination could be used to detect the early and advanced stage of atherosclerosis in superficial layer of human coronary artery.
Topics: Angioscopy; Collagen; Coronary Artery Disease; Coronary Vessels; Humans; Plaque, Atherosclerotic
PubMed: 33162263
DOI: 10.1016/j.jjcc.2020.09.011 -
Circulation Journal : Official Journal... Oct 2023
Topics: Humans; Saphenous Vein; Angioscopy; Graft Occlusion, Vascular; Calcinosis; Vascular Patency
PubMed: 37704440
DOI: 10.1253/circj.CJ-23-0421 -
Circulation. Cardiovascular... Mar 2023Stepwise provisional stenting is the gold standard for percutaneous coronary intervention (PCI) on bifurcation lesions, but the optimal ballooning technique for eventual...
BACKGROUND
Stepwise provisional stenting is the gold standard for percutaneous coronary intervention (PCI) on bifurcation lesions, but the optimal ballooning technique for eventual side branch treatment is not established. The objective of the present study was to compare the stent configuration obtained by 2 different side branch optimization techniques performed after main vessel (MV) stent implantation: proximal optimization technique+kissing balloon inflation+final proximal optimization technique (POT/KBI/POT [PKP]) versus proximal optimization technique+isolated side branch dilation+final proximal optimization technique (POT-side-POT [PSP]).
METHODS
We realized a 1:1 prospective randomized trial comparing bifurcation PCI conducted (under angiographic and angioscopic visualization) with either PKP or PSP in reanimated swine hearts using commercially available drug-eluting stents. After PCI, the obtained stent configuration (expansion, eccentricity, apposition) was assessed by optical coherence tomography and micro-computed tomography dividing the stent in 4 segments. Primary study end point was minimum stent expansion at the distal MV segment.
RESULTS
A total of 30 PCIs were successfully performed according to randomization obtaining overall good results (average minimum stent expansion >90% at optical coherence tomography and micro-computed tomography) with PSP or PKP. Minimum stent expansion at the distal MV segment was significantly higher with PKP as compared with PSP at optical coherence tomography (97.9±4.2% versus 91.0±7.7%; =0.002) and micro-computed tomography (98.1±4.1% versus 91.3±7.9%; =0.006). Other significant findings included higher stent eccentricity index at proximal MV with PSP, higher side branch scaffolding length and lower malapposition (at bifurcation core and distal MV) with PKP.
CONCLUSIONS
This first prospective randomized trial in a unique non-atherosclerotic preclinical environment showed that bifurcation PCI conducted with PSP and PKP achieves different stent configurations. These findings might be useful in bifurcation PCI practice and call for further evaluations in clinical ground.
Topics: Animals; Coronary Angiography; Coronary Artery Disease; Percutaneous Coronary Intervention; Prospective Studies; Stents; Swine; Treatment Outcome; X-Ray Microtomography
PubMed: 36943931
DOI: 10.1161/CIRCINTERVENTIONS.123.012908 -
BMJ Case Reports Jul 2023Little has been reported on the angioscopic and histopathological findings of in-stent restenosis (ISR) in the iliac artery. Here, we report a case of a male patient in...
Little has been reported on the angioscopic and histopathological findings of in-stent restenosis (ISR) in the iliac artery. Here, we report a case of a male patient in his 70s who showed recurrent ISR in the right external iliac artery. We observed the ISR lesions with not only an intravascular ultrasound (IVUS) but also an angioscopy and a biopsy to clarify the mechanism of ISR. These imaging and histopathological findings showed neointimal hyperplasia, and we performed endovascular therapy with covered stent placement to prevent neointimal formation. Not only the IVUS but also the angioscopic and histopathological findings were helpful to clarify the mechanism of ISR and to determine the treatment plan.
Topics: Humans; Male; Angioscopy; Coronary Angiography; Coronary Restenosis; Iliac Artery; Stents; Treatment Outcome; Ultrasonography, Interventional; Aged
PubMed: 37474140
DOI: 10.1136/bcr-2023-256241