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Circulation Journal : Official Journal... 2011Clarification of frequency and distribution of yellow plaques and disrupted plaques will increase understanding of acute coronary syndrome (ACS) onset.
BACKGROUND
Clarification of frequency and distribution of yellow plaques and disrupted plaques will increase understanding of acute coronary syndrome (ACS) onset.
METHODS AND RESULTS
Consecutive patients with ACS (n=75) or without ACS (n=90) who received coronary angioscopic examination were studied. Distance from ostium to yellow plaques, diameter stenosis and vessel wall irregularity at the site of yellow plaques, their yellow color grade (grade 13) and if they had thrombus were analyzed. Yellow plaques with thrombus were regarded as disrupted. Average number of yellow plaques, grade-3 yellow plaques and disrupted yellow plaques per vessel was 4.0, 0.87 and 1.0, respectively. The number of grade-3 yellow plaques and disrupted yellow plaques per vessel were larger in ACS than in non-ACS patients. Yellow plaques were distributed diffusely in the right coronary artery but more in mid-segments in the left anterior descending coronary artery and left circumflex coronary artery. Diameter stenosis in the non-culprit segments was severer at disrupted than at non-disrupted yellow plaques. Vessel wall irregularity was detected more frequently at disrupted than at non-disrupted yellow plaques.
CONCLUSIONS
Approximately 4 yellow plaques, 1 grade-3 yellow plaque and 1 disrupted yellow plaque were detected per vessel. About 25% of detected yellow plaques were disrupted. More grade-3 yellow plaques and disrupted yellow plaques were detected in ACS than in non-ACS patients. These findings strengthen the association between yellow plaques detected by angioscopy and ACS events.
Topics: Acute Coronary Syndrome; Aged; Angioscopy; Aspirin; Clopidogrel; Coronary Artery Disease; Disease Progression; Female; Humans; Incidence; Male; Middle Aged; Myocardial Infarction; Plaque, Atherosclerotic; Platelet Aggregation Inhibitors; Retrospective Studies; Severity of Illness Index; Ticlopidine
PubMed: 21187655
DOI: 10.1253/circj.cj-10-0724 -
JACC. Cardiovascular Imaging May 2009We sought to examine by angioscopy the neointima formation and thrombogenic potential of the neointima after deployment of a drug-eluting stent (DES). (Comparative Study)
Comparative Study
OBJECTIVES
We sought to examine by angioscopy the neointima formation and thrombogenic potential of the neointima after deployment of a drug-eluting stent (DES).
BACKGROUND
Late stent thrombosis after DES implantation, a major safety concern, has been associated with poor strut coverage by neointima. Intracoronary angioscopy provides a method for visual evaluation of stent coverage by neointima and detection of thrombus in the stented coronary segment.
METHODS
Patients undergoing implantation of a sirolimus DES (n = 57) were serially examined by angioscopy immediately after (baseline) and again at 10 months (follow-up) after implantation. The angioscopic color grade of the neointima from white to yellow was assessed in a semiquantitative manner. Stent coverage was classified into not covered (Grade 0), covered by a thin layer (Grade 1), or buried under neointima (Grade 2). The thrombogenic potential of the neointima was evaluated by the prevalence of thrombus on the neointima.
RESULTS
The maximum yellow color grade of the neointima within DES-implanted lesions increased significantly from baseline to follow-up (1.4 +/- 1.1 vs. 1.9 +/- 0.6, p = 0.0008). Even among lesions without yellow color at baseline, yellow color was detected in 94% (17 of 18) of lesions at follow-up. The prevalence of thrombus was significantly higher on the yellow than on the white neointimal areas. Thrombus was detected on yellow and/or Grade-0/1 neointima, but never on the white Grade-2 neointima.
CONCLUSIONS
Sirolimus DES promoted formation of atherosclerotic yellow neointima in the stent-implanted lesion at 10-month follow-up. Thrombus was detected more often on the yellow area than on the white area and was never detected where a stent was buried under white neointima. These data suggest that the increased potential risk of late stent thrombosis in DES lesions may be due to the newly formed yellow neotima and cholesterol-laden plaque.
Topics: Aged; Angioplasty, Balloon, Coronary; Angioscopy; Cardiovascular Agents; Coronary Angiography; Coronary Artery Disease; Coronary Vessels; Drug-Eluting Stents; Female; Follow-Up Studies; Humans; Male; Metals; Middle Aged; Prosthesis Design; Retrospective Studies; Sirolimus; Thrombosis; Time Factors; Treatment Outcome; Tunica Intima
PubMed: 19442950
DOI: 10.1016/j.jcmg.2008.12.026 -
Journal of Interventional Cardiology Oct 2010Pulmonary embolism (PE) is often fatal and its incidence is increasing worldwide. Detection of thromboemboli (TEi) is essential for a definitive diagnosis of PE. The... (Comparative Study)
Comparative Study
Angioscopic detection of pulmonary thromboemboli: with special reference to comparison with angiography, intravascular ultrasonography, and computed tomography angiography.
INTRODUCTION
Pulmonary embolism (PE) is often fatal and its incidence is increasing worldwide. Detection of thromboemboli (TEi) is essential for a definitive diagnosis of PE. The detection of TEi using most imaging methods is low in patients clinically suspected of having PE. This study was carried out to detect TEi in the pulmonary arterial trees by angioscopy (AS); to classify TEi; and to compare the sensitivity of detection for TEi among AS, angiography (AG), intravascular ultrasonography (IVUS), and computed tomography angiography (CTA) in patients with clinically suspected PE.
METHODS
After CTA, AG, and IVUS, the pulmonary arterial trees were surveyed by AS in 49 patients clinically suspected of having PE.
RESULTS
TEi were found by AS, AG, IVUS, and CTA in 81.6%, 24.4%, 34.8%, and 22.5% of 49 patients, respectively. The 48 TEi classified by AS were globular (35%), mural (10%), cap-like (8%), web-like (4%), patchy (33%), and micro (18%). Cap-like, patchy, and micro-TEi were not detectable by AG, IVUS, and CTA in any subjects. TEi color was classified as red, white, yellow, and red-and-yellow in a mosaic pattern in 10%, 31%, 38%, and 18%, respectively. Red and white globular TEi were observed in acute, and red-and-yellow TEi in both acute and chronic PE patients. TEi other than globular were observed in both patient groups.
CONCLUSION
Although invasive, AS is superior to AG, IVUS, and CTA for the detection of TEi, and therefore is a helpful imaging method for the definitive diagnosis of PE.
Topics: Angioscopy; Coronary Angiography; Female; Health Status Indicators; Health Surveys; Humans; Incidence; Male; Middle Aged; Pulmonary Artery; Pulmonary Embolism; Sensitivity and Specificity; Thrombolytic Therapy; Tomography, X-Ray Computed; Ultrasonography, Interventional
PubMed: 20500544
DOI: 10.1111/j.1540-8183.2010.00549.x -
Circulation Journal : Official Journal... Aug 2018Detection of yellow plaques (YP) by coronary angioscopy (CAS) 1 year after 1st-generation drug-eluting stent (DES) implantation has been related to future coronary... (Observational Study)
Observational Study
Association of Subclinical Intrastent Thrombus Detected 9 Months After Implantation of 2nd-Generation Drug-Eluting Stent With Future Major Adverse Cardiac Events - A Coronary Angioscopic Study.
BACKGROUND
Detection of yellow plaques (YP) by coronary angioscopy (CAS) 1 year after 1st-generation drug-eluting stent (DES) implantation has been related to future coronary events. However, the association between CAS findings and clinical outcomes following 2nd-generation DES implantation has not been investigated. Methods and Results: This study included a total of 248 2nd-generation DES in 179 patients, who were examined by CAS 9±2 months after implantation. Angioscopic evaluation included dominant neointimal coverage (NIC) grade, heterogeneity of NIC, presences of YP and intrastent thrombus. The outcome measure was major adverse cardiac events (MACE) defined as a composite of cardiac death, acute myocardial infarction and any coronary revascularization. The association between the CAS findings and MACE was evaluated using the Kaplan-Meier method. A Cox proportional hazards model was used to assess the predictors of MACE. The mean follow-up duration was 1,367±843 days. Dominant NIC grade (P=0.98), heterogeneity of NIC (P=0.20) and YP (P=0.53) were not associated with the incidence of MACE. However, intrastent thrombus was significantly associated with MACE (P=0.033). Intrastent thrombus (adjusted hazard ratio: 2.22; 95% confidence interval [CI]: 1.12-4.39), acute coronary syndrome (2.83; 95% CI: 1.42-5.67) and B2/C lesion (2.13; CI: 1.12-4.05) were independent predictors of MACE.
CONCLUSIONS
Subclinical intrastent thrombus observed by CAS at 9 months after 2nd-generation DES implantation was independently associated with poor clinical outcome.
Topics: Acute Coronary Syndrome; Aged; Coronary Angiography; Coronary Artery Disease; Coronary Thrombosis; Drug-Eluting Stents; Female; Follow-Up Studies; Graft Occlusion, Vascular; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Myocardial Infarction; Percutaneous Coronary Intervention; Plaque, Atherosclerotic; Treatment Outcome
PubMed: 29973431
DOI: 10.1253/circj.CJ-18-0098 -
Journal of the American College of... May 1994Percutaneous intracoronary angioscopy was used to study the morphologic changes occurring in coronary arteries after balloon or laser angioplasty. (Comparative Study)
Comparative Study
OBJECTIVES
Percutaneous intracoronary angioscopy was used to study the morphologic changes occurring in coronary arteries after balloon or laser angioplasty.
BACKGROUND
Angioscopy is thought to provide details of the coronary vessel lumen and the inner wall.
METHODS
Coronary lesions were studied in 44 patients with a 4.5F Imagecath angioscope before and after each interventional procedure. Balloon and laser angioplasty were performed in 21 (group I) and 23 patients (group II), respectively. There was no difference in age, gender or angiographic lesion appearance before the procedure between the two groups.
RESULTS
Circumferential visualization of the target lesion was successfully completed in 17 group I and 19 group II patients. A larger lumen than that observed at baseline was seen in all 17 group I and in 13 of the 19 group II patients. Tissue remnants were observed in all group I and II patients. Laser irradiation resulted in characteristic sharp-edged craters. Dissection was identified in 2 of 19 patients before versus 9 of 19 patients after balloon angioplasty (p < 0.05) and in 0 of 23 patients before versus 4 of 23 patients after laser angioplasty (p = NS). Subintimal hemorrhage was observed in 3 of 19 patients before versus 11 of 19 patients after balloon angioplasty (p < 0.05) and in 2 of 23 patients before versus 4 of 23 patients after laser angioplasty (p = NS). The frequency of hemorrhage was higher in group I than in group II (11 of 19 vs. 4 of 23, respectively, p < 0.02).
CONCLUSIONS
Angioscopy provides valuable information on lesion morphology after coronary interventions. Balloon dilation results in a high rate of dissection and subintimal hemorrhage. Laser angioplasty is able to ablate obstructing tissue and results in a lower rate of subintimal hemorrhage than balloon dilation.
Topics: Aged; Angioplasty, Balloon, Coronary; Angioplasty, Balloon, Laser-Assisted; Angioscopes; Angioscopy; Chi-Square Distribution; Coronary Disease; Coronary Vessels; Female; Humans; Male; Middle Aged; Postoperative Complications
PubMed: 8176089
DOI: 10.1016/0735-1097(94)90373-5 -
Journal of the American College of... Dec 2001To clarify the healing process of disrupted culprit plaques of acute myocardial infarction (MI), we serially observed the culprit plaques for 18 months after the onset...
OBJECTIVES
To clarify the healing process of disrupted culprit plaques of acute myocardial infarction (MI), we serially observed the culprit plaques for 18 months after the onset of acute MI by angioscopy.
BACKGROUND
Although it has been reported that disruption of the yellow plaque and subsequent thrombosis cause acute MI and that the thrombogenicity of the plaque lasts for a month, the healing process of the plaque after disruption has not been clarified.
METHODS
Eighty-five patients with acute MI were prospectively and consecutively enrolled. Angioscopic studies were performed immediately and at 1, 6 and 18 months after successful reperfusion. The prevalence of yellow plaques and thrombus was examined. The color grade of the plaque was determined as 0 (white), 1 (light yellow), 2 (yellow) or 3 (bright yellow).
RESULTS
Although yellow plaque was present at the culprit lesion in most patients throughout follow-up, its color grade was reduced from one to six months (1.9 +/- 0.6 vs. 1.1 +/- 0.7, p = 0.0003) after reperfusion, especially in the patients without hyperlipidemia (HL). The incidence of thrombus was 92.5% immediately after reperfusion, which was reduced significantly to 63.8%, 4.8% and 11.8% at 1, 6 and 18 months, respectively. The incidence of thrombus (77.8% vs. 45.0%, p = 0.03) at one month was higher in the patients with diabetes mellitus (DM).
CONCLUSIONS
The healing process of yellow plaques at the culprit lesions of MI was detected by angioscopy as reductions of color grade and thrombogenicity at six months and partially at one month after the onset of acute MI. This healing process appears to deteriorate by complicating cases of DM or HL.
Topics: Aged; Angioplasty, Balloon, Coronary; Angioscopy; Coronary Artery Disease; Coronary Thrombosis; Coronary Vessels; Diabetes Mellitus, Type 2; Female; Follow-Up Studies; Humans; Hyperlipidemias; Male; Middle Aged; Myocardial Infarction; Myocardial Reperfusion Injury; Prospective Studies; Risk Factors; Stents; Thrombolytic Therapy; Wound Healing
PubMed: 11738294
DOI: 10.1016/s0735-1097(01)01673-4 -
JACC. Cardiovascular Interventions May 2009We conducted this study to assess the prevalence and determinants of subclinical thrombus after sirolimus-eluting stent (SES) implantation.
OBJECTIVES
We conducted this study to assess the prevalence and determinants of subclinical thrombus after sirolimus-eluting stent (SES) implantation.
BACKGROUND
Angioscopic analyses have demonstrated the presence of thrombus is more common than the clinical incidence of SES thrombosis.
METHODS
Fifty-three patients (53 lesions) underwent 6-month follow-up optical coherence tomography. A stent eccentricity index ([SEI] minimum/maximum stent diameter) was determined in each cross section. To evaluate unevenness of neointimal thickness, a neointimal unevenness score ([NUS] maximum neointimal thickness in the cross section/average neointimal thickness of the same cross section) was calculated for each cross section. Average SEI and NUS were calculated for each stent. Major adverse cardiac events were defined as a composite of death, myocardial infarction, and target vessel revascularization.
RESULTS
Fourteen cases of thrombus (26%) were detected by optical coherence tomography (thrombus: n = 14 vs. nonthrombus: n = 39). The percentage of thrombus was associated with longer stents (36.4 +/- 20.2 mm vs. 25.1 +/- 9.8 mm; p = 0.008), a larger number of uncovered struts (17 +/- 16 vs. 8 +/- 11; p = 0.03), smaller average SEI (0.89 +/- 0.04 vs. 0.92 +/- 0.03; p = 0.001), and greater average NUS (2.22 +/- 0.24 vs. 2.00 +/- 0.33; p = 0.03). A significant relationship existed between average SEI and average NUS (p < 0.0001, R = 0.68), and between average SEI and the number of uncovered struts (p < 0.0006, R = 0.46). There was no significant difference in major adverse cardiac events during follow-up (median: 485 days, 7.1% vs. 12.8%; p > 0.99).
CONCLUSIONS
Longer stents and greater asymmetric stent expansion may be important determinants of thrombus formation after SES implantation. In this small cohort, the presence of thrombus did not increase the risk of major adverse cardiac events.
Topics: Aged; Angioplasty, Balloon, Coronary; Aspirin; Clopidogrel; Coronary Restenosis; Coronary Thrombosis; Drug-Eluting Stents; Female; Humans; Immunosuppressive Agents; Japan; Male; Multivariate Analysis; Platelet Aggregation Inhibitors; Prospective Studies; Risk Assessment; Risk Factors; Sirolimus; Ticlopidine; Tomography, Optical Coherence; Ultrasonography, Interventional
PubMed: 19463471
DOI: 10.1016/j.jcin.2009.03.003 -
Journal of Cardiology Jun 2013Diabetes mellitus (DM) is a major risk factor for cardiovascular events. The study purpose was to compare DM and non-DM (nDM) patients in terms of statin-induced change...
Plaque stabilization by intensive LDL-cholesterol lowering therapy with atorvastatin is delayed in type 2 diabetic patients with coronary artery disease-Serial angioscopic and intravascular ultrasound analysis.
BACKGROUND
Diabetes mellitus (DM) is a major risk factor for cardiovascular events. The study purpose was to compare DM and non-DM (nDM) patients in terms of statin-induced change of plaque characteristics using intravascular ultrasound (IVUS) and coronary angioscopy.
METHODS
Patients with coronary artery disease and hypercholesterolemia who were enrolled to the TWINS were selected and classified into two groups: DM group and nDM group. Eleven DM patients and 28 nDM patients were studied.
RESULTS
Low-density lipoprotein cholesterol levels decreased significantly to a similar extent at weeks 28 and 80 from baseline in DM and nDM (p<0.001). The mean angioscopic color grades of yellow plaques in DM and nDM were similar at baseline and significantly decreased at week 80 from baseline in both groups, however, the mean change of angioscopic color grade from baseline in DM were not significantly decreased and the mean angioscopic color was significantly higher than that in nDM (1.34 vs. 1.00, p<0.05) at week 28. IVUS showed plaque volume reduction in both groups (p<0.01) except at week 80 in DM group, which was not statistically significant different compared to the baseline.
CONCLUSION
In DM patients, plaque volume regression by atorvastatin was shown to be attenuated, and its color improvement was significantly delayed. However, the yellowness became comparable between DM and nDM groups at week 80. These results indicate that patients with DM should be treated by intensive lipid-lowering therapy with atorvastatin for at least 80 weeks to stabilize vulnerable plaque.
Topics: Aged; Angioscopy; Anticholesteremic Agents; Atorvastatin; Cholesterol, LDL; Coronary Artery Disease; Diabetes Mellitus, Type 2; Female; Follow-Up Studies; Heptanoic Acids; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Hypercholesterolemia; Male; Middle Aged; Plaque, Atherosclerotic; Pyrroles; Risk Factors; Time Factors; Ultrasonography, Interventional
PubMed: 23478121
DOI: 10.1016/j.jjcc.2013.01.010 -
Journal of Cardiology Cases Jun 2020The patient was a 19-year-old woman who had experienced headache for 1 year. Soon after birth, ventricular septal defects were diagnosed, the size of which were small,...
The patient was a 19-year-old woman who had experienced headache for 1 year. Soon after birth, ventricular septal defects were diagnosed, the size of which were small, therefore not requiring surgical repair. She also noticed hypertension, with up to 184/110 mmHg of blood pressure. Her physical examination revealed a difference in blood pressure between her upper and lower limbs (160/108 and 92/65 mmHg, respectively). A cardiac computed tomography image clearly demonstrated the narrowing of the aortic isthmus. Coarctation of the aorta (CoA) was definitively diagnosed and was the cause of the upper limb hypertension and headache. Cardiac catheterization revealed 3.8 mm of the aortic isthmus and 65 mmHg of the peak-to-peak pressure gradient across the CoA. The patient was offered endovascular therapy of the CoA. A non-covered stent implantation was successfully performed and the pressure gradient across the aortic isthmus disappeared. Her upper limb hypertension also improved. Aortic angioscopy revealed a yellow plaque on the aortic intima, located proximal to the coarctation site, which was exposed owing to high blood pressure. Our case highlights that an atherosclerotic change can develop even in young patients with hypertension. <: An aortic angioscope can detect an early atherosclerotic change of aorta, which other imaging modalities such as computed tomography and intravascular ultrasonography cannot show. An early atherosclerosis can develop even in a young patient with hypertension; therefore, coarctation of the aorta should be diagnosed and treated appropriately as soon as possible.>.
PubMed: 32547662
DOI: 10.1016/j.jccase.2020.03.001 -
Journal of Cardiothoracic Surgery Sep 2006Several minimally invasive saphenous vein harvesting techniques have been developed to reduce morbidities associated with coronary artery bypass grafting. This... (Comparative Study)
Comparative Study Randomized Controlled Trial
BACKGROUND
Several minimally invasive saphenous vein harvesting techniques have been developed to reduce morbidities associated with coronary artery bypass grafting. This prospective, randomized study was designed to compare two commonly used minimally invasive saphenous vein harvesting techniques, the SaphLITE Retractor System (Teleflex Medical) and the Clearglide Endoscopic Vessel Harvesting System (Ethicon CardioVations, Inc.).
METHODS
Between January 2003 and March 2004, a total of 200 patients scheduled for primary, nonemergent coronary artery bypass grafting, with or without concomitant procedures were randomized into two groups: SaphLITE (n = 100) and Clearglide (n = 100). Pre-, intra- and postoperative data was collected and subjected to statistical analysis. Randomization provided homogenous groups with respect to preoperative risk factors.
RESULTS
Harvest location for the SaphLITE group was thigh (n = 40), lower leg (n = 5) and both lower leg and thigh (n = 55). The location of harvest for the Clearglide group was thigh (n = 3), lower leg (n = 16) and both lower leg and thigh (n = 81). The mean incision length was 3.6 cm (range, 2-6) in the SaphLITE group versus 2.1 cm (range, 1-4) in the Clearglide group (p < 0.05). The total incision length was 12.9 cm versus 8.9 (p < 0.05) in the SaphLITE and Clearglide groups. Conversion to the open technique occurred in 5 SaphLITE patients and 7 Clearglide patients. Intraoperative leg exploration for bleeding occurred in two of the Clearglide patients and none of the SaphLITE patients. Post-operative complications specifically related to minimally invasive harvesting technique, including a two-week post-discharge visit, were not statistically different between the groups.
CONCLUSION
The saphenous vein can be safely harvested utilizing the SaphLITE and Clearglide systems. While the Clearglide system allows for fewer incisions (number and length) and less harvest time, these benefits may be outweighed by the increased cost of the Clearglide system compared to the SaphLITE retractor.
Topics: Adult; Aged; Aged, 80 and over; Angioscopes; Female; Humans; Male; Middle Aged; Prospective Studies; Saphenous Vein; Tissue and Organ Harvesting
PubMed: 16953895
DOI: 10.1186/1749-8090-1-24