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JACC. Case Reports May 2020Aortogenic embolization is among the major mechanisms of cryptogenic stroke. Angioscopic surveillance of the aortic wall clearly visualized the existence of thrombi and...
Aortogenic embolization is among the major mechanisms of cryptogenic stroke. Angioscopic surveillance of the aortic wall clearly visualized the existence of thrombi and spontaneously ruptured plaques, which dynamically liberated embolic materials. ().
PubMed: 34317329
DOI: 10.1016/j.jaccas.2020.02.023 -
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 -
Circulation Journal : Official Journal... 2011Glistening yellow coronary plaques (GY) seen on angioscopy are considered vulnerable to disruption. Collagen fiber (CF) is the main substance that protects coronary... (Clinical Trial)
Clinical Trial
BACKGROUND
Glistening yellow coronary plaques (GY) seen on angioscopy are considered vulnerable to disruption. Collagen fiber (CF) is the main substance that protects coronary plaques against mechanical stress. Therefore, whether angioscopically defined vulnerable plaques correlate with those defined histologically was investigated.
METHODS AND RESULTS
One hundred and thirty-two excised human coronary plaques were classified by angioscopy into 19 GY, 49 non-glistening yellow plaques (non-GY) and 64 white plaques, and their relation to CF density was examined. CF-dense (>15/100 µm), CF-loose (>5 and <15/100 µm), and CF-scanty (<5/100 µm) plaques were hypothesized to be stable, relatively stable, and vulnerable, respectively. Histologically the plaques were classified into non-lipid deposition, superficial lipid deposition and diffuse lipid deposition groups; the diffuse lipid deposition group was classified into necrotic core (NC) and non-NC types. Nineteen GY were composed of 4 with superficial lipid deposition, 4 with non-NC type of diffuse lipid deposition, and 11 with NC type. Sixteen (84%) of these were CF scanty. Forty-nine (100%) of non-GY and 57 (89%) of white plaques were CF dense or CF loose The sensitivity, specificity and predictive value of GY in detecting histologically vulnerable plaques were 90%, 97% and 84%, respectively, indicating that GY represented histologically vulnerable plaques.
CONCLUSIONS
These pathohistological characteristics might indicate that GY, less-protected plaques against mechanical stress, are vulnerable plaques.
Topics: Aged; Angioscopy; Coronary Vessels; Female; Humans; Lipid Metabolism; Male; Middle Aged; Plaque, Atherosclerotic; Stress, Mechanical
PubMed: 21670541
DOI: 10.1253/circj.cj-10-1286 -
Journal of the American College of... Jan 1991The feasibility of using a flexible, steerable angioscope to perform coronary angioscopy before and after percutaneous coronary angioplasty was tested. The... (Clinical Trial)
Clinical Trial
The feasibility of using a flexible, steerable angioscope to perform coronary angioscopy before and after percutaneous coronary angioplasty was tested. The microangioscope fits through an 8F coronary angioplasty guiding catheter and contains a multifiber viewing bundle incorporated into the body of a 4.3F balloon catheter with a central lumen for distal flushing and guide-wire passage. Angioscopy was performed without complications 45 times in 24 patients, including 6 patients with stable and 18 with unstable angina. Circumferential visualization of the target lesion was successful in 20 (83%) of the 24 patients and improved with operator experience. Excellent visualization of the target lesion was achieved in 16 (94%) of the last 17 patients. Plaque, thrombus and dissection were among the abnormal findings in the 20 patients (4 with stable, 16 with unstable angina) in whom circumferential viewing of the target lesion was achieved. In four patients with restenosis after angioplasty, the lesion morphology was distinctly different from that of lesions in arteries without prior angioplasty. In patients with stable angina, no thrombus or dissection was seen by angiography or angioscopy before angioplasty. In patients with unstable angina, thrombus was detected more frequently by angioscopy than by angiography before angioplasty (8 versus 2 of 16) and after (15 versus 2 of 16) angioplasty. Intimal dissection was also seen much more frequently by angioscopy than by angiography before angioplasty (7 versus 0 of 16) and after angioplasty (16 versus 7 of 16). It is concluded that high resolution percutaneous coronary angioscopy can be performed safely in conjunction with balloon angioplasty. Further investigation is needed before this diagnostic tool can be applied clinically.
Topics: Angina Pectoris; Angina, Unstable; Angioplasty, Balloon, Coronary; Coronary Disease; Coronary Vessels; Endoscopes; Feasibility Studies; Female; Humans; Male; Middle Aged; Recurrence
PubMed: 1987210
DOI: 10.1016/0735-1097(91)90710-q -
Texas Heart Institute Journal Sep 1986Devices for visualizing blood vessels have evolved from a rigid, illuminated tube (1913), to a tube with an added convex lens (1922), to one with a transparent...
Devices for visualizing blood vessels have evolved from a rigid, illuminated tube (1913), to a tube with an added convex lens (1922), to one with a transparent inflatable balloon for displacing blood from the line of vision (1943), to a flexible angioscope (1960s). Recent fiberoptic developments make it possible to visualize the orifices of the coronary arteries and simultaneous laser angioplasty. The characteristic fluorescence of hematoporphyrin derivative under ultraviolet light has been visualized angioscopically in experimental atherosclerotic plaque, where it accumulates and acts as a marker. However, several requirements need to be met in order for angioscopy to fulfill its therapeutic possibilities in angioplasty, thrombolytic therapy, intraoperative inspection of vascular anastomoses, and its diagnostic potential in distinguishing plaques from clots and pulmonary embolisms from other obstructions. These requirements are: (1) variously-sized angioscopes to accommodate iliac, femoral, renal, and coronary arteries; (2) percutaneous introducers in the various sizes to prevent back-bleeding; (3) a more flexible, easily manipulated fiberoptic; (4) a sufficiently inflatable balloon tip; (5) cross hairs and reference points in the optical system; and (6) optimal focal lengths for the areas to be visualized.
PubMed: 15226857
DOI: No ID Found -
Circulation Journal : Official Journal... 2011Over the past decade, multidetector row computed tomography (MDCT) has become the most reliable and established of the noninvasive examination techniques for detecting...
Over the past decade, multidetector row computed tomography (MDCT) has become the most reliable and established of the noninvasive examination techniques for detecting coronary heart disease. Now MDCT is chasing intravascular ultrasound (IVUS) in terms of spatial resolution. Among the components of vulnerable plaque, MDCT may detect lipid-rich plaque, the lipid pool, and calcified spots using computed tomography number. Plaque components are detected by MDCT with high accuracy compared with IVUS and angioscopy when assessing vulnerable plaque. The TWINS study and TOGETHAR trial demonstrated that angioscopic loss of yellow color occurred independently of volumetric plaque change by statin therapy. These 2 studies showed that plaque stabilization and regression reflect independent processes mediated by different mechanisms and time course. Noncalcified plaque and/or low-density plaque was found to be the strongest predictor of cardiac events, regardless of lesion severity, and act as a potential marker of plaque vulnerability. MDCT may be an effective tool for early triage of patients with chest pain who have a normal ECG and cardiac enzymes in the emergency department. MDCT has the potential ability to analyze coronary plaque quantitatively and qualitatively if some problems are resolved. MDCT may become an essential tool for detecting and preventing coronary artery disease in the future.
Topics: Aged; Coronary Angiography; Coronary Artery Disease; Disease Progression; Evidence-Based Medicine; Female; Humans; Male; Plaque, Atherosclerotic; Predictive Value of Tests; Prognosis; Risk Assessment; Rupture, Spontaneous; Time Factors; Tomography, X-Ray Computed
PubMed: 21532180
DOI: 10.1253/circj.cj-11-0252 -
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 -
JACC. Cardiovascular Interventions Feb 2010The purpose of this study is to compare the neointimal formational pattern and incidence of thrombus formation among sirolimus-eluting (SES), paclitaxel-eluting (PES),... (Comparative Study)
Comparative Study
OBJECTIVES
The purpose of this study is to compare the neointimal formational pattern and incidence of thrombus formation among sirolimus-eluting (SES), paclitaxel-eluting (PES), and bare-metal stents (BMS) with coronary angioscopy.
BACKGROUND
Neointimal formation and incidence of mural thrombus are different with the type of stent.
METHODS
One hundred successive patients who received 43 SES, 40 PES, or 32 BMS implantation underwent 6-month follow-up coronary angioscopy. We evaluated angioscopic parameters, including minimum and maximum neointimal grade; presence and number of red mural thrombus; neointimal grade around thrombus; and heterogeneity score, which is defined by subtracting minimum from maximum grade within 1 stent by classifying angioscopic neointimal coverage grades into 4 categories. We compared these parameters among 3 kinds of stent groups.
RESULTS
Heterogeneity scores of SES, PES, and BMS were 0.79 +/- 0.60, 1.27 +/- 0.75, and 1.03 +/- 0.82, respectively (p = 0.011). The PES showed the highest incidence of angioscopic red mural thrombus (50% in PES, 12% in SES, and 3% in BMS, p < 0.001), and the number of thrombus observed within 1 stent in the PES group tended to be larger than those in the SES and BMS groups.
CONCLUSIONS
At 6 months after stent implantation, PES showed the most heterogeneous neointimal formation and the highest incidence of thrombus formation compared with SES and BMS.
Topics: Aged; Angioscopy; Antineoplastic Agents, Phytogenic; Coronary Angiography; Coronary Thrombosis; Female; Humans; Immunosuppressive Agents; Incidence; Logistic Models; Male; Middle Aged; Paclitaxel; Risk Factors; Sirolimus; Stents; Time Factors
PubMed: 20170880
DOI: 10.1016/j.jcin.2009.10.031 -
Circulation Journal : Official Journal... 2011The aim of this study was to compare the effect of atorvastatin treatment on high-grade yellow coronary plaques (grade ≥ 2, group H) vs. low-grade yellow plaques...
BACKGROUND
The aim of this study was to compare the effect of atorvastatin treatment on high-grade yellow coronary plaques (grade ≥ 2, group H) vs. low-grade yellow plaques (grade ≤ 1, group L).
METHODS AND RESULTS
Twenty-nine hypercholesterolemic patients with coronary heart disease were treated with atorvastatin (10-20mg/day) for 80 weeks and were divided into 2 groups by baseline plaque color grade. The angioscopic plaque grade and the vessel, plaque, and luminal volumes were measured by intravascular ultrasound at baseline and in weeks 28 and 80. The plaque color grade decreased significantly from baseline to weeks 28 and 80 in group H (2.27 ± 0.48, 1.47 ± 0.75, and 1.55 ± 0.86, respectively), but not significantly in group L (0.90 ± 0.31, 0.83 ± 0.61, and 0.89 ± 0.56, respectively). The plaque volume of group HP was greater than that of group LP (respectively 158.0 ± 45.8 vs. 107.5 ± 21.9 mm(3) at baseline, 144.5 ± 41.1 vs. 97.5 ± 24.8mm(3) in week 28, and 128.8 ± 31.5 vs. 87.9 ± 31.5mm(3) in week 80 (P < 0.001 by ANCOVA between groups).
CONCLUSIONS
The plaque-stabilizing effect of atorvastatin was stronger for more vulnerable plaques with a higher color grade, although regression of plaque during atorvastatin therapy was noted irrespective of plaque vulnerability.
Topics: Analysis of Variance; Angioscopy; Atorvastatin; Coronary Artery Disease; Female; Heptanoic Acids; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Hypercholesterolemia; Lipids; Male; Middle Aged; Plaque, Atherosclerotic; Predictive Value of Tests; Pyrroles; Rupture, Spontaneous; Severity of Illness Index; Time Factors; Treatment Outcome; Ultrasonography, Interventional
PubMed: 21502706
DOI: 10.1253/circj.cj-10-1035 -
Journal of the American College of... Sep 1994This study was undertaken to compare coronary angioscopy with angiography for the detection of intimal dissection and intracoronary thrombus. (Comparative Study)
Comparative Study
OBJECTIVES
This study was undertaken to compare coronary angioscopy with angiography for the detection of intimal dissection and intracoronary thrombus.
BACKGROUND
It has been demonstrated previously that coronary angioscopy provides more intravascular detail than cineangiography. Both imaging methods have to be compared directly to assess the additional diagnostic value of angioscopy.
METHODS
The angiograms and videotapes of 52 patients who had undergone angioscopy were reviewed independently by two observers unaware of other findings. Classic angiographic definitions were used for dissection and thrombus. Angioscopic dissection was defined as visible cracks or fissures on the lumen surface or mobile protruding structures that are contiguous with the vessel wall. Angioscopic thrombus was defined as a red, white or mixed red and white intraluminal mass.
RESULTS
Angiography and angioscopy were in agreement in 40.4% of cases in the absence of thrombus and in 11.5% in the presence of thrombus. No fewer than 25 (48.1%) angioscopically observed thrombi remained undetected at angiography. With angioscopy as the standard, although the specificity of angiography for thrombus was 100%, sensitivity was very low at 19%. Angioscopic dissection was present in 40 patients (76.9%) versus angiographic dissection in 15 patients (28.8%). With regard to dissection, there was no correlation between the two imaging methods (r phi = 0.15, p = 0.29).
CONCLUSIONS
Coronary angiography underestimates the presence of intracoronary thrombus. Angioscopy and angiography are complementary techniques for detecting and grading intimal dissections.
Topics: Adult; Aged; Aortic Dissection; Angioscopy; Coronary Aneurysm; Coronary Angiography; Coronary Thrombosis; Coronary Vessels; Female; Humans; Male; Middle Aged; Predictive Value of Tests; Sensitivity and Specificity
PubMed: 8077534
DOI: 10.1016/0735-1097(94)90010-8