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HeartRhythm Case Reports Nov 2022
PubMed: 36618593
DOI: 10.1016/j.hrcr.2022.07.020 -
The Journal of Invasive Cardiology Feb 2022The current guidelines recommend at least 6 months of antithrombotic and antibiotic prophylaxis following atrial septal occluding device placement using the phrase...
The current guidelines recommend at least 6 months of antithrombotic and antibiotic prophylaxis following atrial septal occluding device placement using the phrase "until endothelialization." However, neo-endothelialization has not been assessed in vivo in humans. Considering the atrial septal defect occluding device, several autopsy cases and device extraction cases only demonstrated insufficient endothelialization beyond 6 months after implantation caused endocarditis and thrombosis. Accordingly, we have successfully developed a method for determining device endothelialization using angioscopy. This method helped us evaluate the endothelialization of a 25 mm Amplatzer PFO occluder device (Abbott) in a 40-year-old man 12 months after implantation. This is the first report evaluating the PFO occluder device in vivo.
Topics: Adult; Angioscopy; Cardiac Catheterization; Foramen Ovale, Patent; Humans; Male; Septal Occluder Device; Treatment Outcome
PubMed: 35100559
DOI: No ID Found -
Circulation Journal : Official Journal... Apr 2009The aim of this study was to elucidate the time course of atorvastatin-induced changes in vulnerable plaque using angioscopy and intravascular ultrasound (IVUS). (Clinical Trial)
Clinical Trial
BACKGROUND
The aim of this study was to elucidate the time course of atorvastatin-induced changes in vulnerable plaque using angioscopy and intravascular ultrasound (IVUS).
METHODS AND RESULTS
Fifty-seven hypercholesterolemic patients with coronary artery disease (CAD) were treated with atorvastatin (10-20 mg/day) for 80 weeks and then coronary plaques were evaluated with angioscopy and IVUS. Angioscopic images were classified into 6 grades (0-5) based on yellow color intensity. A 20-mm segment containing angioscopically-identified yellow plaque was also examined by IVUS to measure atheroma volume. The mean angioscopic grade of 58 yellow plaques significantly decreased from 1.5 (95% confidence interval [CI] 1.2 to 1.8) to 1.1 (95%CI 0.9 to 1.3, P=0.012) at week 28 and 1.2 (95%CI 0.9 to 1.4, P=0.024) at week 80. Mean volume of 30 lesions, including the 58 yellow plaques, significantly reduced -8.3% (95%CI -11.5 to -5.2) at week 28 (P<0.001 for baseline vs week 28) and -17.8% (95%CI -23.9 to -11.8) at week 80 (P<0.001 for baseline vs week 80).
CONCLUSIONS
In patients with CAD treated with atorvastatin, serial analysis with angioscopy demonstrated early loss of yellow color in plaques, and IVUS volumetric analysis showed subsequent plaque regression. Both changes possibly indicate reduction of plaque vulnerability in an additive manner.
Topics: Aged; Angioscopy; Anticholesteremic Agents; Atorvastatin; Coronary Artery Disease; Coronary Vessels; Female; Heptanoic Acids; Humans; Male; Middle Aged; Pyrroles; Time Factors; Ultrasonography, Interventional
PubMed: 19225206
DOI: 10.1253/circj.cj-08-0755 -
Clinical Cardiology Feb 1985The purpose of this study is to describe the use of angioscopes in flowing bloodstreams of animals and humans, to demonstrate the ability to precisely deliver laser...
The purpose of this study is to describe the use of angioscopes in flowing bloodstreams of animals and humans, to demonstrate the ability to precisely deliver laser energy to an intravascular target using visual guidance and to determine the information content and spatial content of angioscopy. Angioscopy was performed in 5 living dogs, 16 cadaver vascular segments, and 14 patients at the time of peripheral or coronary bypass surgery. Five canine femoral artery segments received angioscopically directed intravascular Nd:YAG laser irradiation. We were able to precisely direct the laser irradiation to predetermined intimal targets. Gross tissue injury varied from none to carbonization and vascular perforation, depending on incident energy. Using a variety of flexible fiberoptic endoscopes ranging in diameter from 1.5 to 3.7 mm, we were able to visualize intravascular structures including plaque, suture lines, venous valves, and thrombi in living patients. No patient incurred complications of any sort. We conclude that angioscopy using flexible endoscopes can be performed safely, can provide clinically useful information, and may provide a means for delivering visually directed intravascular laser irradiation.
Topics: Animals; Arterial Occlusive Diseases; Arteriosclerosis; Blood Vessel Prosthesis; Carotid Artery Diseases; Coronary Artery Bypass; Coronary Disease; Dogs; Endoscopes; Endoscopy; Graft Occlusion, Vascular; Humans; Laser Therapy; Postoperative Complications; Saphenous Vein; Thrombosis; Vascular Diseases
PubMed: 3871680
DOI: 10.1002/clc.4960080202 -
Circulation Journal : Official Journal... 2011A low ratio of serum eicosapentaenoic acid to arachidonic acid (EPA/AA) has been associated with cardiovascular events. Higher-grade yellow color coronary plaques are...
BACKGROUND
A low ratio of serum eicosapentaenoic acid to arachidonic acid (EPA/AA) has been associated with cardiovascular events. Higher-grade yellow color coronary plaques are associated with higher plaque vulnerability and higher thrombogenic potential. Therefore, the association between EPA/AA ratio and yellow color grade of coronary plaques was examined.
METHODS AND RESULTS
Consecutive patients (n=54) who underwent percutaneous coronary intervention were enrolled in this study. The serum EPA/AA ratio was examined on admission. All patients underwent an angioscopic examination of the culprit vessel to examine the color grade of yellow plaques (0, white; 1, slight yellow; 2, yellow; and 3, intense yellow) and the presence of thrombus. Excluding 16 patients with acute coronary syndrome (ACS), 38 patients with stable angina were divided into 2 groups according to their EPA/AA ratio: the low EPA/AA group (n=19, EPA/AA ratio <0.37 [median]) and the high EPA/AA group (n=19, EPA/AA ratio ≥0.37). The maximum color grade (2.5 ± 0.5 vs. 1.9 ± 0.9; P=0.01) of yellow plaques was significantly higher and the number of non-culprit yellow plaques with thrombus (1.7 ± 0.8 vs. 1.2 ± 1.1; P=0.06) tended to be higher in low EPA/AA than in high EPA/AA stable angina patients. Multivariate analysis revealed that the serum EPA level (odds ratio=0.98, 95% confidence interval=0.96-0.99, P=0.03) was associated with the presence of grade-3 yellow plaques.
CONCLUSIONS
A low serum EPA level and a low EPA/AA ratio was associated with high vulnerability of coronary plaques.
Topics: Aged; Arachidonic Acid; Color; Coronary Thrombosis; Disease Susceptibility; Eicosapentaenoic Acid; Fatty Acids, Omega-3; Fatty Acids, Omega-6; Female; Humans; Male; Middle Aged; Plaque, Atherosclerotic
PubMed: 21778590
DOI: 10.1253/circj.cj-11-0352 -
European Heart Journal. Case Reports Oct 2022Angioscopy plays an important role providing much information regarding vessel surfaces as macro-pathology in living patients. However, its viewing field is sometimes...
BACKGROUND
Angioscopy plays an important role providing much information regarding vessel surfaces as macro-pathology in living patients. However, its viewing field is sometimes limited due to insufficient removal of blood flow and a catheter that cannot be controlled to view the intended direction. Angioscopy from a retrograde approach was found to overcome these limitations.
CASE SUMMARY
A 68-year-old man was admitted to our hospital with acute intermittent claudication for 2 weeks. He was diagnosed with acute limb ischaemia (ALI) in his left superficial femoral artery, and revascularization by endovascular treatment was attempted. A bi-directional approach was needed for successful revascularization with thrombus aspiration and angioplasty. Subsequent angioscopic examination from the retrograde approach visualized a clear and adequate image of the vessel and helped identify the aetiology of the case as on-site thrombosis at an atherosclerotic lesion.
DISCUSSION
It is important to understand the aetiology of ALI in each case for the management of the patient. Angioscopy can be a useful modality to identify the aetiology. It was found that retrograde angioscopy has several advantages over antegrade angioscopy in clear visualization and intentional control of the angioscopy catheter. This methodology may help us identify the aetiology of ALI by evaluating the vessel walls of patients with peripheral artery disease more precisely.
PubMed: 36225806
DOI: 10.1093/ehjcr/ytac393 -
Journal of Atherosclerosis and... Mar 2022We aimed to validate the subjective and qualitative angioscopic findings by the objective and quantitative near-infrared spectroscopic (NIRS) assessment to compensate... (Observational Study)
Observational Study
AIM
We aimed to validate the subjective and qualitative angioscopic findings by the objective and quantitative near-infrared spectroscopic (NIRS) assessment to compensate each other's drawbacks.
METHODS
This is a single-center prospective observational study. Patients undergoing a planned follow-up coronary angiography after percutaneous coronary intervention were prospectively enrolled from January 2018 to April 2019. The major three vessels were examined by NIRS-intravascular ultrasound, followed by coronary angioscopic evaluation. Yellow color grade on angioscopy was classified into four grades (0, white; 1, slight yellow; 2, yellow; and 3, intensive yellow) at a location of maximal lipid core burden index over 4 mm [LCBI (4)] on NIRS in each vessel.
RESULTS
A total of 95 lesions in 44 patients (72.6±6.7 years, 75% male) were analyzed. LCBI (4) was significantly different among different yellow color grades by coronary angioscopy (ANOVA, p<0.001). Positive correlation was found between angioscopic yellow color grade and LCBI (4) (beta coefficient 164.8, 95% confidence interval 122.9-206.7; p<0.001). The best cutoff value of LCBI (4) to predict the presence of yellow plaque (yellow color grade ≥ 2) was 448 (sensitivity 79.3%, specificity 69.7%, C-statistic 0.800, 95% confidence interval 0.713-0.887, p<0.001).
CONCLUSION
The qualitative angioscopic assessment was objectively validated by the quantitative NIRS evaluation, which would be helpful for the reinterpretation of the existing evidences of both imaging modalities.
Topics: Aged; Angioscopy; Coronary Artery Disease; Coronary Vessels; Female; Follow-Up Studies; Humans; Lipids; Male; Plaque, Atherosclerotic; Predictive Value of Tests; Prospective Studies; Spectroscopy, Near-Infrared; Ultrasonography, Interventional
PubMed: 33487618
DOI: 10.5551/jat.60566 -
Circulation Journal : Official Journal... Oct 2020The detailed mechanism of early-phase arterial healing after novel fluoropolymer-based paclitaxel-eluting stent (PES) implantation in the femoropopliteal (FP) lesions...
BACKGROUND
The detailed mechanism of early-phase arterial healing after novel fluoropolymer-based paclitaxel-eluting stent (PES) implantation in the femoropopliteal (FP) lesions has not been elucidated.Methods and Results:We evaluated the intravascular status of 20 PES implanted in 11 FP lesions of 9 patients using angioscopy at approximately 3 months after implantation. Angioscopic images were analyzed to determine (1) the dominant degree of neointimal coverage (NIC) over the stent; (2) the extent of uncovered struts; and (3) the presence of intrastent thrombus. NIC was classified into 4 grades: grade 0, stent struts fully visible; grade 1, stent struts bulging into the lumen although covered; grade 2, stent struts embedded in neointima, but translucently visible; grade 3, stent struts fully embedded and invisible. The extent of uncovered struts was scored as follows: score 0, no uncovered struts of the entire stent; score 1, uncovered struts area approximately <30% of the stent; and score 2, uncovered struts area approximately ≥30% of the stent. In total, 90% of stents demonstrated grade 1 dominant NIC and 10% showed grade 2 dominant NIC; 85% of stents showed an uncovered stent score of 0, and the remainder had a score of 1. Thrombus was observed in all stents.
CONCLUSIONS
Widely uncovered stent struts were not observed by angioscopy at 3 months after PES implantation in these FP lesions, even with the detection of thrombus adhesion.
Topics: Angioscopy; Coronary Vessels; Drug-Eluting Stents; Femoral Artery; Humans; Neointima; Paclitaxel; Popliteal Artery; Treatment Outcome
PubMed: 32981923
DOI: 10.1253/circj.CJ-20-0551 -
American Heart Journal Aug 1995The purpose of the present study was to use the complementary information of angiography, intravascular ultrasound, and intracoronary angioscopy before and after... (Clinical Trial)
Clinical Trial
The purpose of the present study was to use the complementary information of angiography, intravascular ultrasound, and intracoronary angioscopy before and after directional atherectomy to characterize the postatherectomy appearance of vessel wall contours and the mechanism of lumen enlargement. Directional coronary atherectomy aims at debulking rather than dilating a coronary artery lesion. The selective removal of the plaque may potentially minimize the vessel wall damage and lead to subsequent better late outcome. Whether plaque removal is the main mechanism of action has only to be assessed indirectly by angiography and warrants further investigation with detailed analysis of luminal changes and vessel wall damage by ultrasound and direct visualization with angioscopy. Twenty-six patients have been investigated by quantitative angiography, intravascular ultrasound, and intracoronary angioscopy (n = 19) before and after atherectomy. In addition, all retrieved specimens were microscopically examined. Ultrasound imaging showed an increase in lumen area from 1.95 +/- 0.70 mm2 to 7.86 +/- 2.16 mm2 at atherectomy. The achieved gain mainly resulted from plaque removal because plaque plus media area decreased from 18.16 +/- 4.47 mm2 to 13.13 +/- 3.10 mm2. Vessel wall stretching (i.e., change in external elastic lamina area) accounted for only 15% of lumen area gain. Luminal gain was higher in noncalcified (6.52 +/- 2.12 mm2) lesions than in lesions containing deeply located calcium (5.19 +/- 0.99 mm2) and lowest in superficially calcified lesions (5.41 +/- 2.41 mm2). Ultrasound imaging identified an atherectomy byte in 85% of the cases, whereas angioscopy revealed such a crevice in 74%. The complementary use of the three techniques revealed an underestimation of the presence of dissection/tear and new thrombus by angiography (10% and 4%) and ultrasound imaging (12% and 0%) compared with angioscopy (26% and 21%). The combined use of angiography, ultrasound, and angioscopy reveals that the postatherectomy luminal lining is not as regular and smooth as that seen by angiography. Luminal enlargement with atherectomy is achieved by plaque excision rather than arterial expansion.
Topics: Aged; Angioscopy; Atherectomy, Coronary; Calcinosis; Chi-Square Distribution; Coronary Angiography; Coronary Artery Disease; Coronary Thrombosis; Coronary Vessels; Female; Humans; Male; Middle Aged; Ultrasonography, Interventional
PubMed: 7631599
DOI: 10.1016/0002-8703(95)90432-8 -
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