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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 -
Journal of Cardiology Sep 2018Coronary artery vasospasm (CS) can be identified as either a diffuse type or focal type; however, the difference in endothelial characteristics between these spasm types... (Observational Study)
Observational Study
BACKGROUND
Coronary artery vasospasm (CS) can be identified as either a diffuse type or focal type; however, the difference in endothelial characteristics between these spasm types remains unclear. The features of coronary intima associated with diffuse spasm and focal spasm using coronary angioscopy (CAS) were evaluated and the optical coherence tomography (OCT) findings were compared.
METHODS
CAS and/or OCT observational analysis was performed in 55 patients (mean age: 61.4 years, 31 men) who had acetylcholine-provoked CS (diffuse CS, 31 patients; focal CS, 24 patients). The yellowness of the intima, presence of thrombus in CAS, and intimal characteristics based on the OCT results were evaluated.
RESULTS
CAS showed more atherosclerotic yellow plaques at the focal spasm segment than at the diffuse spasm segment (p=0.032). Moreover, there were more thrombi at the focal spasm segment (p=0.039). In addition, OCT results revealed that the intima area, maximum intima thickness, and lipid content in the focal CS group were larger than the diffuse CS group (4.22±1.67mm vs. 3.45±2.36mm; 0.71±0.29mm vs. 0.53±0.30mm; 55.9% vs. 32.0%, p<0.001, respectively).
CONCLUSIONS
These results indicate that the presence of atherosclerotic plaques at the spasm site is likely to be related to the occurrence of a focal vasospasm. This may support the difference of features between focal CS and diffuse CS and contribute to precise treatment for each spasm type.
Topics: Acetylcholine; Aged; Angioscopy; Coronary Vasospasm; Coronary Vessels; Female; Humans; Male; Middle Aged; Plaque, Atherosclerotic; Thrombosis; Tomography, Optical Coherence; Tunica Intima; Vasodilator Agents
PubMed: 29898865
DOI: 10.1016/j.jjcc.2018.04.013 -
International Journal of Cardiology.... Jun 2018The purpose of this study is to elucidate the impact of out-stent plaque characteristics on vascular response after implantation of second generation drug-eluting stent...
Impact of out-stent plaque characteristics on vascular response after second generation drug-eluting stent implantation: iMAP-intravascular ultrasound and angioscopic study.
PURPOSE
The purpose of this study is to elucidate the impact of out-stent plaque characteristics on vascular response after implantation of second generation drug-eluting stent (G2-DES).
METHODS
Enrolled were 37 patients with 39 coronary artery lesions into which three types of G2-DES were successfully implanted (9 Nobori biolimus-, BES; 15 Xience everolimus-, EES; 15 Resolute zotarolimus-eluting stents; R-ZES). Immediately after (baseline) and one year after the implantation (follow-up), iMAP-intravascular ultrasound (IVUS) was performed to measure out-stent plaque volume (OSPV) and its components. Percent OSPV and vulnerable plaque index (VPI) were defined as percentile of OSPV to vessel volume and as percentile of lipidic plus necrotic volume to OSPV. Coronary angioscopy at follow-up rated the degree of arterial repair by neointimal stent coverage (NSC).
RESULTS
Poor NSC was found in approximately 60% of each G2-DES. In BES, % OSPV at baseline was significantly greater in poor NSC than in good NSC (36.2 ± 3.9 vs. 27.3 ± 4.0%, P = 0.01). In EES, %OSPV was significantly greater in poor NSC than in good NSC (41.0 ± 4.1 vs. 32.6 ± 2.7%, P < 0.01). In R-ZES implantation, there was no significant difference with regards to %OSPV between poor and good NSC. In BES, VPI at baseline was significantly greater in poor NSC than good NSC (54.0 ± 5.8 vs. 42.2 ± 5.1%, P = 0.02). There was no significant difference with regards to VPI between poor and good NCS in EES and R-ZES.
CONCLUSIONS
Impact of out-stent plaque characteristics on vascular response was different among the three types of G2-DES.
PubMed: 29892708
DOI: 10.1016/j.ijcha.2018.05.004 -
BMJ Case Reports Mar 2018
Topics: Aged, 80 and over; Angioscopy; Aortic Rupture; Diagnosis, Differential; Hemorrhage; Humans; Intermittent Claudication; Male; Neovascularization, Pathologic; Plaque, Atherosclerotic
PubMed: 29593007
DOI: 10.1136/bcr-2018-224801 -
JACC. Cardiovascular Interventions Jan 2018
Topics: Aged; Angioscopy; Cineangiography; Coronary Angiography; Coronary Artery Disease; Coronary Circulation; Coronary Vessels; Drug-Eluting Stents; Female; Humans; Percutaneous Coronary Intervention; Plaque, Atherosclerotic; Predictive Value of Tests; Time Factors; Tomography, Optical Coherence; Treatment Outcome
PubMed: 29248411
DOI: 10.1016/j.jcin.2017.10.012 -
The Journal of International Medical... Mar 2018An angioscope was used to observe the intima of the aorta in an 82-year-old patient who had undergone thoracic endovascular aortic repair. The aortic angioscopic...
An angioscope was used to observe the intima of the aorta in an 82-year-old patient who had undergone thoracic endovascular aortic repair. The aortic angioscopic findings showed vulnerable plaques from the ascending aorta to the aortic arch that had not been visualized using preoperative computed tomography. After deploying a stent graft from zone 1 to zone 4, the proximal edge of the stent graft was adjacent to the ruptured plaque with mixed thrombi. In spite of these findings, the patient had an uneventful recovery. Angioscopy may have the potential to stratify the risk of thoracic endovascular aortic repair-related complications.
Topics: Aged, 80 and over; Angioscopy; Aorta, Thoracic; Aortic Aneurysm; Computed Tomography Angiography; Endovascular Procedures; Female; Humans; Plaque, Atherosclerotic; Stents
PubMed: 28984176
DOI: 10.1177/0300060517731681 -
The Journal of Invasive Cardiology Aug 2017Several strategies have been envisioned to reduce the risk of contrast-induced nephropathy, but the most modifiable approach for a treating physician is to minimize...
Contrast Minimization With the New-Generation DyeVert Plus System for Contrast Reduction and Real-Time Monitoring During Coronary and Peripheral Procedures: First Experience.
BACKGROUND
Several strategies have been envisioned to reduce the risk of contrast-induced nephropathy, but the most modifiable approach for a treating physician is to minimize contrast administration. To date, there is no report on the use of Osprey Medical's new-generation DyeVert Plus system in coronary or peripheral applications. We aimed to appraise the role of the DyeVert Plus system inclusive of contrast reduction and real-time monitoring in a consecutive series of patients undergoing coronary or peripheral invasive procedures.
METHODS
Baseline, procedural, and outcome details for patients undergoing coronary or peripheral invasive procedures were collected from our institutional database. We primarily focused on total and relative amount of contrast saved, as calculated and displayed by the DyeVert Plus system.
RESULTS
The DyeVert Plus system was used in 10 patients. All procedures were successfully completed with adequate and high-quality angioscopic and angiographic images. No adverse events occurred up to discharge in any patients, with the notable exception of 1 case of asymptomatic and uneventful contrast-induced nephropathy. Average contrast volume was 79.9 ± 48.8 mL (95% confidence interval [CI], 53.2 to 109.4), thanks to an absolute saving of 55.8 ± 31.9 mL (95% CI, 39.1 to 76.7; P<.05) and a relative saving of 41.8 ± 7.3% (95% CI, 37.5 to 46.4; P<.05). Comparison of contrast volume estimates between DyeVert Plus vs manual measurements showed a minimal difference of 1.6 ± 1.9 mL (95% CI, 2.9 to 0.5; P<.05).
CONCLUSION
Use of the new-generation DyeVert Plus system inclusive of contrast reduction and real-time monitoring is feasible in both coronary and peripheral applications while significantly reducing contrast volume.
Topics: Aged; Angiography; Blood Vessels; Contrast Media; Coronary Artery Disease; Dose-Response Relationship, Drug; Drug Delivery Systems; Drug Dosage Calculations; Drug Monitoring; Female; Humans; Italy; Kidney Diseases; Male; Middle Aged; Peripheral Vascular Diseases; Treatment Outcome
PubMed: 28756419
DOI: No ID Found -
BMJ Case Reports Jul 2017
Topics: Angioscopy; Coronary Aneurysm; Coronary Angiography; Coronary Vessels; Humans; Male; Middle Aged; Plaque, Atherosclerotic; Tomography, X-Ray Computed; Ultrasonography
PubMed: 28739628
DOI: 10.1136/bcr-2017-221306 -
Circulation Journal : Official Journal... Feb 2018
Topics: Acute Coronary Syndrome; Adult; Atherosclerosis; Calcinosis; Coronary Aneurysm; Coronary Angiography; Heart Arrest; Humans; Male; Mucocutaneous Lymph Node Syndrome
PubMed: 28652533
DOI: 10.1253/circj.CJ-17-0342 -
The International Journal of... Oct 2017Coronary calcification is a risk factor for ischemic heart disease. Hydroxyapatite that is formed by polymerization from calcium phosphate tribasic (CPT) is the major...
Coronary calcification is a risk factor for ischemic heart disease. Hydroxyapatite that is formed by polymerization from calcium phosphate tribasic (CPT) is the major constituent of coronary calcium deposits. If CPT could be visualized, coronary calcification could be predicted and prevented. We discovered that when CPT and collagen I, the main constituent of collagen fibers, are mixed with lac dye (LD) and then exposed to fluorescent light excited at 345 ± 15 nm and emitted at 420 nm, a purple fluorescence that is characteristic of CPT only is elicited. So, we examined localization of CPT and its relation to plaque morphology by color fluorescent angioscopy (CFA) or microscopy (CFM) in 24 coronary arteries obtained from 12 autopsy subjects. By CFA, the incidence (%) of CPT as confirmed by purple fluorescence in 15 normal segments, 25 white plaques, 14 yellow plaques without necrotic core (NC) and 8 yellow plaques with NC was 20, 36, 64 and 100 (p < 0.05 vs. normal segments), respectively. By CFM, the CPT was either deposited alone amorphously or surrounded hydroxyapatite that was identified by Oil Red O, methylene blue and von Kossa's stain. The results suggested that CFA using LD is feasible for imaging CPT, that is a precursor of hydroxyapatite, in human coronary plaques, and this technique would help prediction and discovery of a preventive method of coronary calcification.
Topics: Aged; Angioscopy; Autopsy; Azo Compounds; Biomarkers; Calcium Phosphates; Collagen Type I; Coronary Artery Disease; Coronary Vessels; Durapatite; Female; Fluorescent Dyes; Humans; Luminescent Measurements; Male; Middle Aged; Necrosis; Optical Imaging; Plaque, Atherosclerotic; Predictive Value of Tests; Vascular Calcification
PubMed: 28432452
DOI: 10.1007/s10554-017-1142-y