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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 -
European Heart Journal May 2024
Topics: Humans; Cerebral Infarction; Cholesterol; Angioscopy; Male; Crystallization; Aged; Female; Middle Aged
PubMed: 38239148
DOI: 10.1093/eurheartj/ehad861 -
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 -
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 -
Annals of Biomedical Engineering Dec 2023Peripheral arterial diseases are commonly managed with endovascular procedures, which often face limitations in device control and visualization under X-ray fluoroscopy...
Peripheral arterial diseases are commonly managed with endovascular procedures, which often face limitations in device control and visualization under X-ray fluoroscopy guidance. In response, we developed the CathCam, an angioscope integrated into an expandable cable-driven parallel mechanism to enhance real-time visualization, precise device positioning and catheter support for successful plaque crossing. The primary objective of this study was to assess and compare the performance of the novel CathCam with respect to conventional catheters and the CathPilot (i.e., CathCam without the angioscope), for applications in crossing chronic total occlusions (CTO). We first assessed the system in 3D-printed phantom models, followed by an ex vivo evaluation with CTO samples from a patient's superficial femoral artery. We measured and compared success rates, crossing times, and fluoroscopy times in both experiments. The CathCam demonstrated a 100% success rate in phantom experiments and a 75% success rate in ex vivo experiments with CTO samples, compared to conventional catheters, with 35% and 25% success rates, respectively. The average crossing times for the CathCam and the conventional catheter were 31 s and 502 s for the phantom experiments and 210 s and 511 s for the actual CTO lesions. The Cathcam also showed to be a reliable endovascular imaging approach in an in vivo experiment. Compared to conventional catheters, the CathCam significantly increased the success rate and reduced crossing and fluoroscopy times in both phantom and ex vivo setups. CathCam can potentially improve clinical outcomes for minimally invasive endovascular interventions by offering high-resolution real-time imaging alongside accurate device control.
Topics: Humans; Angioscopes; Catheters; Endovascular Procedures; Femoral Artery; Peripheral Arterial Disease; Treatment Outcome; Chronic Disease
PubMed: 37561231
DOI: 10.1007/s10439-023-03344-5 -
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 -
Neurosurgery Dec 2023Complementary metal oxide semiconductor (CMOS) electrode arrays are a novel technology for miniaturized endoscopes; however, its use for neurointervention is yet to be...
BACKGROUND AND OBJECTIVES
Complementary metal oxide semiconductor (CMOS) electrode arrays are a novel technology for miniaturized endoscopes; however, its use for neurointervention is yet to be investigated. In this proof-of-concept study, we aimed to demonstrate the feasibility of CMOS endoscopes in a canine model by providing direct visualization of the endothelial surface, deploying stents and coils, and accessing the spinal subdural space and skull base.
METHODS
Using 3 canine models, standard guide catheters were introduced into the internal carotid and vertebral arteries through the transfemoral route using fluoroscopy. A 1.2-mm CMOS camera was delivered through the guide catheter to inspect the endothelium. Next, the camera was introduced alongside standard neuroendovascular devices including coils and stents to provide direct visualization of their deployment within the endothelium during fluoroscopy. One canine was used for skull base and extravascular visualization. A lumbar laminectomy was performed, and the camera was navigated within the spinal subdural space until the posterior circulation intracranial vasculature was visualized.
RESULTS
We successfully visualized the endothelial surface and performed several endovascular procedures such as deployment of coils and stents under direct endovascular, angioscopic vision. We also demonstrated a proof of concept for accessing the skull base and posterior cerebral vasculature using CMOS cameras through the spinal subdural space.
CONCLUSION
This proof-of-concept study demonstrates the feasibility of CMOS camera technology to directly visualize endothelium, perform common neuroendovascular procedures, and access the base of the skull in a canine model.
Topics: Animals; Dogs; Skull Base; Endovascular Procedures; Stents; Fluoroscopy; Catheters
PubMed: 37377420
DOI: 10.1227/neu.0000000000002584 -
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. 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 -
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