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PubMed1998

Vein quality in infrainguinal revascularisation: assessment by angioscopy and histology.

The concept of vein quality has been slow to gain widespread acceptance, but an increasing body of evidence suggests that vein quality is relevant to the success of bypass grafting for peripheral vascular disease. The angioscope represents an additional tool for monitoring and preparing vein grafts during infrainguinal revascularisation. Within the overall theme of vein quality, this paper presents the cumulative experience with vascular endoscopy at Bristol Royal Infirmary. In clinical studies, the diagnostic role of angioscopy in quality control was evaluated by grafting preexisting, angioscopically detected, intraluminal abnormalities and correlating them with histological appearances. There were significant associations between angioscopy/histology grades and graft patency. To enable quantification of images, an innovative computerised video image processing method has been developed and validated against simultaneous ultrasound measurements of segments of saphenous vein. The therapeutic applications of angioscopy in vein graft preparation were studied prospectively in patients undergoing in situ femoropopliteal/distal bypasses by randomisation to full angioscopic or conventional preparation. There was a significant reduction in wound morbidity. Completion angioscopy and arteriography were complementary in the detection of technical defects. Harvested vein was maintained in organ culture to assess further the influence of pre-existing pathology and the potentially traumatic effects of angioscopy on development of neointimal hyperplasia. There was a significant correlation between the extent of pre-existing abnormality and smooth muscle cell proliferative activity in culture and although angioscopy caused endothelial cell loss, this did not stimulate neointimal hyperplasia in vitro. This work confirms that vein quality can be evaluated prospectively by angioscopy and that substandard vein is associated with inferior patency rates. Angioscopic and histological evaluation, together with vein organ culture studies, have definite application in helping to elucidate the mechanisms underlying graft failure.

Adult↗
PubMed1987

Flexible angioscopy seems faster and more specific than arteriography.

Fiberoptic angioscopy was performed with 2.5- and 3.3-mm angioscopes in 25 arteries and grafts in 19 patients. Radiologically normal and abnormal arteries and anastomotic sites were examined. All vessels and grafts were visualized and images of normal arterial wall, subclinical and obstructing atherosclerotic plaque, and suture lines were defined. Unexpected endovascular findings were noted in five patients (26%) and included large amounts of free-floating clot (one patient), atherosclerotic debris (two patients), and membranelike obstructions (two patients). Angioscopy required three to ten minutes and resulted in no complications. Experience with the flexible angioscope indicates that satisfactory visualization and specific recognition of angiographically unsuspected problems can be obtained. The flexible angioscope is faster and appears more etiologically specific than arteriography.

Angiography↗
PubMed1988

Coronary angioscopy during cardiac catheterization and cardiac surgery.

Coronary angioscopy (CA) was performed in 30 patients (pts) during cardiac catheterization (Group 1) and in 11 pts during coronary bypass surgery (Group 2) using ultrathin fiberoptic angioscopes (phi 1.2-1.8 mm). For percutaneous CA (Group 1) the angioscope was introduced through a 9F guiding catheter from the femoral artery. The viewing field was cleared by flushing Ringer's solution and short-time occlusion of the coronary ostium by the guiding catheter. In Group 2 CA was performed retrogradely from the distal arteriotomy and through the bypass vein during flushing with cardioplegic solution. In Group 1 in 17/30 pts the coronary artery could be successfully examined by CA. In 13 pts the obstruction was eccentric and irregular shaped. In 2/5 pts, in whom CA was performed successfully pre and post balloon dilatation, CA after PTCA revealed an intimal rupture without clinical or angiographical signs of the intimal dissection. In Group 2 in 9/11 pts good visualization of stenoses could be achieved. At the obstruction site CA revealed thrombi in 3 pts and ulcer in 1 pts. In contrast to angiography, which estimates the lumen diameter of a segmental lesion, CA gives information about the luminal shape and the underlying substance of the obstruction (e.g. atheroma, thrombus, ulceration). The main problems in percutaneous CA are the insufficient intraluminal guidance, the insufficient depth of view of the angioscopes, and the limited examination time.

Cardiac Catheterization↗
PubMedDate not supplied

Multislice CT virtual angioscopy of the abdomen.

BACKGROUND: Computed tomographic (CT) angiography represents an important clinical tool in the evaluation of vascular disorders. Virtual angioscopy can be reconstructed with volumetric CT data sets. We evaluated the feasibility and clinical value of this application in the assessment of abdominal vessels. METHODS: Data sets of CT angiographic studies obtained with helical (n = 120) and multislice (n = 180) CT scanners were analyzed on a workstation for postprocessing. Vascular evaluation was done on conventional enhanced axial images, three-dimensional reconstructions, and virtual angioscopic images. RESULTS: We made 123 studies in patients without aortic disease. Of the patients evaluated for stent-graft treatment, 63 showed normal patency, seven had partial thrombosis of the stent-graft, five showed total occlusion of the stent-graft, and 10 had leaks. From the 92 remaining CT studies, 63 vascular aneurysms and nine dissections were diagnosed. CONCLUSION: The current technology produces high-quality virtual angioscopic images. Although axial and multiplanar views are usually adequate for detecting a vascular disorder, virtual angioscopic views better define anatomic details.

Abdomen↗
PubMedDate not supplied

PTA and stenting of benign venous stenoses in the pelvis: long-term results.

PURPOSE: To provide follow-up data on endovascular intervention for venous stenoses in the pelvis. METHODS: Between 1985 and 1995, 35 patients presented with 42 stenoses of the pelvic veins after operative thrombectomy and creation of an arteriovenous fistula, combined with intraoperative venous angioscopy. All patients underwent angioplasty and, if unsuccessful, percutaneous insertion of an endovascular stent (n = 7). RESULTS: Angioplasty with and without endovascular stenting was technically successful in 34 of 35 patients (97%). Average length of the stenoses was 20.6 mm (range 10-90 mm), average diameter before dilation 4.1 mm (range 2-6 mm), and average diameter after dilation 10.1 mm (range 5-18 mm). Intraoperative angioscopy showed pathologic findings (intimal laceration or residual thrombotic material) in 14 patients. After an average follow-up period of 4.13 years, 24 (69%) patients had patent veins. The difference in the primary patency rate between patients with angioscopically abnormal veins (6 of 14 patients, corresponding to a patency rate of 43%) and patients with angioscopically normal veins after thrombectomy (18 of 21 patients, corresponding to a patency rate of 86%) was statistically significant (p<0.01, log rank test). CONCLUSIONS: Percutaneous transluminal angioplasty and/or stenting are good treatment modalities for pelvic vein stenosis following surgical thrombectomy. Angioscopically abnormal veins have a poorer long-term patency, regardless of the type of intervention.

Adult↗
PubMed1990

Percutaneous fiberoptic angioscopy of the left ventricle in patients with dilated cardiomyopathy and acute myocarditis.

Left ventricular luminal changes were examined by percutaneous fiberoptic angioscopy in 13 patients with dilated cardiomyopathy and in four patients with acute myocarditis. Angioscope-guided endomyocardial biopsy was also performed in six patients with dilated cardiomyopathy and in two with acute myocarditis. A balloon-tipped guiding catheter (9F) was introduced through the right femoral artery into the left ventricle, the balloon was inflated, and a 1.6 or 4.3F fiberscope was introduced through the catheter into the ventricle so as to locate the fiberscope tip at the tip of the catheter shaft. The balloon was then pushed against the desired portion of the ventricle and warmed saline was infused to observe the luminal changes. In contrast to the patients without organic heart disease whose left ventricular luminal surface was brown in color, the luminal surface was white or light yellow in four, light brown in one, bluish-white in one, with white and brown portions distributed in a mosaic pattern in four, and it was reddish brown in the remaining one patient with dilated cardiomyopathy. Mural thrombi were observed in two of the patients. The luminal surface was light brown in one, reddish brown in one, rose in one, and red in one patient with acute myocarditis. Thrombi and scattered bleeding were observed in two and one of these patients, respectively. The changes in luminal coloration in patients with dilated cardiomyopathy and acute myocarditis had no obvious relation to left ventricular volume and ejection fraction. Angioscope-guided biopsy revealed that the white and light yellow portions were due to endocardial fibrosis, that the endocardia of brown portions were not fibrotic, and that the myocardium in the red portions contained mononuclear cells, indicating inflammation. The results indicate that the angioscopic features of the left ventricular luminal surface were not uniform in patients with dilated cardiomyopathy or in those with acute myocarditis, and that angioscopy can be used as a guiding tool for endomyocardial biopsy.

Acute Disease↗
PubMed1991

Role of angioscopy in the treatment of peripheral vascular disease with percutaneous atherectomy.

The role of adjunctive video angioscopy was evaluated in 43 patients with symptomatic peripheral vascular disease undergoing percutaneous atherectomy with the Simpson atherocath. There were 57 target lesions (superficial femoral, n = 46; popliteal, n = 11) of which 33 were stenotic (86 +/- 11%) and 24 were total occlusions of 0.5 to 10.6 cm in length, determined by angiography. Intraluminal inspection, with angioscopes of 0.85 to 1.5 mm in outer diameter housed within a guide catheter, could be performed in 55 of 57 lesions (96%) before atherectomy and in 39 of these 55 (71%) after atherectomy. Failure to obtain an adequate image was usually due to insufficient irrigation, especially in recanalized vessels. In 13 of 23 successfully recanalized arteries (54%) the occlusion could be crossed by the angioscope itself, whereas in 10 cases (42%) a guidewire or a sheath introducer was necessary. Angioscopic passage revealed that often long total occlusions, determined by angiography, consisted of greater than or equal to 1 discrete occlusion with interposed patent thrombus-free vascular segments. After atherectomy, in 15 instances with an acceptable angiographic result, angioscopy was helpful in identifying residual plaques and flaps which then selectively underwent atherectomy. In conclusion, angioscopy proved to be a useful adjunct to angiography in optimizing vascular recanalization with percutaneous atherectomy.

Adult↗
PubMed1996

Comparison of angioscopy, intravascular ultrasound imaging and quantitative coronary angiography in predicting clinical outcome after coronary intervention in high risk patients.

OBJECTIVES: The purpose of this study was to identify qualitative or quantitative variables present on angioscopy, intravascular ultrasound imaging or quantitative coronary arteriography that were associated with adverse clinical outcome after coronary intervention in high risk patients. BACKGROUND: Patients with acute coronary syndromes and complex lesion morphology on angiography are at increased risk for acute complications after coronary angioplasty. Newer devices that primarily remove atheroma have not improved outcome over that of balloon angioplasty. Intravascular imaging can accurately identify intraluminal and intramural histopathologic features not adequately visualized during coronary arteriography and may provide mechanistic insight into the pathogenesis of abrupt closure and restenosis. METHODS: Sixty high risk patients with unstable coronary syndromes and complex lesions on angiography underwent angioscopy (n = 40) and intravascular ultrasound imaging (n = 46) during interventional procedures. In 26 patients, both angioscopy and intravascular ultrasound were performed in the same lesion. All patients underwent off-line quantitative coronary arteriography. Coronary interventions included balloon (n = 21) and excimer laser (n = 4) angioplasty, directional (n = 19) and rotational (n = 6) atherectomy and stent implantation (n = 11). Patients were followed up for 1 year for objective evidence for recurrent ischemia. RESULTS: Patients whose clinical presentation included rest angina or acute myocardial infarction or who received thrombolytic therapy within 24 h of procedure were significantly more likely to experience recurrent ischemia after intervention. Plaque rupture or thrombus on preprocedure angioscopy or angioscopic thrombus after intervention were also significantly associated with adverse outcome. Qualitative or quantitative variables on angiography, intravascular ultrasound or off-line quantitative arteriography were not associated with recurrent ischemia on univariate analysis. Multivariate predictors of recurrent ischemia were plaque rupture on preprocedure angioscopy (p < 0.05, odds ratio [OR] 10.15) and angioscopic thrombus after intervention (p < 0.05, OR 7.26). CONCLUSIONS: Angioscopic plaque rupture and thrombus were independently associated with adverse outcome in patients with complex lesions after interventional procedures. These features were not identified by either angiography or intravascular ultrasound.

Angioplasty, Balloon, Coronary↗
PubMed2006

Number of yellow plaques detected in a coronary artery is associated with future risk of acute coronary syndrome: detection of vulnerable patients by angioscopy.

OBJECTIVES: We sought to test whether the risk of acute coronary syndrome (ACS) can be estimated by angioscopy. BACKGROUND: Disruption of vulnerable plaque and subsequent thrombosis is regarded as a major mechanism of ACS. Although yellow plaques are supposedly vulnerable, the association between angioscopically determined extent of coronary atherosclerosis and risk of ACS events has not been reported. METHODS: Patients (n = 552) who received catheterization and angioscopic examination for the diagnosis of coronary artery diseases were prospectively included and followed up for new onset of ACS events. Yellow color intensities of all detected yellow plaques were graded as 1, 2, or 3 according to the standard colors. Number of yellow plaques (NYP) in a coronary artery and maximum color grade of detected yellow plaques (maxYP) were determined. Association between the incidence of ACS events and angioscopic findings were analyzed. RESULTS: Follow-up interval was 57.3 +/- 22.1 months. Acute coronary syndrome events were detected in 39 patients (7.1%). Although maxYP was not statistically different (2.0 +/- 0.7 vs. 1.8 +/- 0.9; p = 0.18), NYP was higher in the patients with an ACS event than those without the event (3.1 +/- 1.8 vs. 2.2 +/- 1.5; p = 0.008). Patients with NYP > or =2 and those with NYP > or =5 had 2.2- and 3.8-fold higher event rates, respectively, than those with NYP 0 or 1 (9.0% and 15.6%, respectively, vs. 4.1%; p = 0.02). Multivariate logistic regression analysis revealed NYP and multivessel disease as the independent risk factors of ACS events. CONCLUSIONS: Patients with multiple yellow plaques per vessel have a higher risk of suffering ACS events than those with NYP 0 or 1. Angioscopy would be useful to detect vulnerable patients.

Acute Disease↗
PubMed1998

Morphologic comparison of atherosclerotic lesions in native coronary arteries and saphenous vein graphs with intracoronary angioscopy in patients with unstable angina.

BACKGROUND: Coronary vein grafts develop accelerated atherosclerosis after aortocoronary bypass surgery. Previous pathologic studies have suggested that the morphologic appearance of atherosclerotic lesions in saphenous vein grafts may have subtle differences compared with those of native coronary arteries and may be more prone to disruption and thrombus formation. However, a comparative in vivo assessment of the angioscopic morphology differences between these two types of vessels has not been reported previously. We compared the angioscopic lesion morphology of native coronary arteries and saphenous vein grafts in patients with unstable angina. METHODS AND RESULTS: Percutaneous coronary angioscopy was performed in 60 consecutive patients with unstable angina. Plaque color, texture, friability, and the presence of atherosclerotic plaque ulceration or intracoronary thrombus were noted in the culprit lesion. The culprit lesion was located in native coronary arteries in 42 (70%) patients and in a saphenous vein graft in 18 (30%) patients. There were no significant differences in age, sex, and coronary risk factors including tobacco use, hypertension, hypercholesterolemia, or diabetes mellitus between the two populations. There were also no significant differences between the two groups in terms of plaque color, surface texture, or the incidence of complex plaque morphology (plaque ulceration and intracoronary thrombosis). Loosely adherent, friable plaque, detected by angioscopy, was absent in native coronary arteries and was present in 44% of the saphenous vein grafts (p < 0.0001). CONCLUSIONS: The results of our angioscopic study indicate that other than a high incidence of plaque friability in vein grafts, the surface morphology of culprit lesions in unstable angina patients is quite similar for saphenous vein grafts and native coronary arteries.

Angina, Unstable↗
PubMed1997

Angioscopy variables predictive of early angiographic outcome after excimer laser-assisted coronary angioplasty.

This study attempted to determine whether anatomic findings at angioscopy were associated with adverse early angiographic outcomes following excimer laser-assisted coronary angioplasty. Predictive factors of either coronary abrupt vessel closure or early (< or =24 hours) restenosis after percutaneous coronary angioplasty, including clinical and angiographic variables, have been widely evaluated. The role of angioscopic findings may contribute to identification of patients at risk for early poor outcome. Thirty-seven patients with severe lesions, including 23 total occlusions which underwent successful percutaneous transluminal coronary angioplasty (PTCA) with laser irradiation and adjunctive balloon dilatation (n = 35), or stand alone laser (n = 2), had concomitant angioscopic imaging of the target vessel. All patients had a 24-hour angiographic follow up. Early unfavorable outcome (n = 15) was defined as abrupt vessel closure or restenosis (> or = 50% stenosis) at 24 hours. By multivariate logistic regression analysis, immediate post-PTCA residual percent stenosis was associated with a poor outcome (restenosis: 33 +/- 22% vs no restenosis: 21 +/- 14%, p = 0.05). Angioscopic red thrombus aspect was the most significant correlate for early closure or restenosis (7 of 15 patients with unfavorable outcome vs 2 of 22 patients with favorable outcome, odds ratio, 22.9; p < 0.01) and was associated with a significantly higher early minimal lumen diameter loss (1 +/- 0.8 mm in the presence of a red thrombus vs 0.3 +/- 0.5 mm without thrombus, p < 0.005). Red thrombus appearance is associated with an unfavorable early angiographic outcome in patients who undergo laser-assisted coronary angioplasty.

Aged↗
PubMed1989

Percutaneous video angioscopy in peripheral vascular disease.

Percutaneous video angioscopy was performed using high resolution thin angioscopes in 12 peripheral arteries in 10 patients with peripheral vascular disease, to study the intraluminal appearance before and after dynamic, laser and conventional balloon angioplasty. Clear blood free views of the whole length of artery instrumented were obtained in 10 arteries with the remaining two arteries being partially visualised. The angioscopic appearances were compared to angiography. Clinically significant findings were detected in all the arteries by angioscopy that were not found by angiography. These included thrombus in the artery and vascular sheath, intimal flaps and fractured atheroma. The angioscopic findings helped to assess the effects of angioplasty in different types of occlusion. The findings demonstrate the potential of percutaneous angioscopy as an aid to percutaneous angioplasty as well as being a powerful diagnostic procedure.

Aged↗
PubMed1985

Coronary angioscopy during cardiac catheterization.

Coronary angioscopy should permit direct inspection of the luminal cross section and identification of disease. The feasibility of introducing a 5F Olympus Ultrathin fiberscope into the obstructed right coronary artery in five patients after routine cardiac catheterization by the brachial approach was therefore tested. An 8.3F USCI woven Dacron angioplasty guiding catheter was modified to enlarge its lumen. After engaging the right coronary ostium with the catheter, an attempt was made to pass the angioscope coaxially to the tip of the catheter. Visualization of the coronary lumen was then achieved in three patients by manually injecting 5 to 10 cc of normal saline solution through the guiding catheter at 2 to 3 cc/s. White atheromatous plaque could be seen near the site of obstruction in each case. In two patients, a lack of sufficient flexibility in the distal 2 cm of the angioscope prevented passage to the catheter tip. Preliminary experience with a videoendoscopic system suggests that this monitoring technique is essential for the adequate performance of angioscopy and for recording dynamic changes during blood displacement. Geometric distortion of the image and nonlinearities in magnification and light reflex with a decreasing lens to object distance make quantitative evaluation of the lumen difficult. Lack of an angulation system further contributes to this problem and, more importantly, restricts passage of the angioscope to the proximal 1 to 2 cm segments of coronary arteries. Although coronary angioscopy may have research and clinical applications in the future, these technical problems should first be addressed.

Angiography↗
PubMed1995

Value of angioscopy for intraoperative assessment of carotid endarterectomy.

From March 1992 to November 1993 we used angioscopy and arteriography for intraoperative assessment of 103 carotid endarterectomies in 96 patients. The indication for surgery was asymptomatic stenosis in 55 cases and neurologic and/or ocular symptoms in 48. Intraoperative angioscopy and arteriography were performed to allow comparison of findings. Intraoperative angioscopic images were normal in 67 cases and abnormal in 36. The defect was an intimal flap in 26 cases, detachment of the distal plaque in seven cases, and an intimal wedge in five cases. In two cases both detachment and a wedge were observed. The defect was not considered severe enough to warrant revision in 31 cases and was corrected in five cases by either vein bypass (n = 1) or revision of the endarterectomy (n = 4). In the latter four cases repeat angioscopy showed normal findings. Arteriographic and angioscopic findings were compared in 102 cases. In the 71 cases in which angioscopic findings were normal, arteriography revealed a major abnormality in three cases: kinking in one and stenosis > 40% in two. Kinking was treated by attachment of the common carotid artery and stenosis by venous bypass. In the 31 cases in which angioscopy revealed defects not considered to warrant revision, arteriography revealed stenosis > 40% in three cases treated by either prosthetic bypass (n = 2) or revision of the endarterectomy (n = 1). The false negative rate for angioscopy was 5.9% and concordance between the two methods was 94.1%. The combined mortality-morbidity rate was 1.9% (one stroke and one death). Postoperative evaluation of anatomic findings by arteriography or Doppler ultrasonography revealed asymptomatic internal carotid occlusion in one and internal carotid stenosis < 30% in four cases. Angioscopy is a simple, low-cost method in intraoperative control that can be used either as an adjunct to arteriography or as an alternative if arteriography cannot be performed.

Adult↗
PubMed2002

Alternative greater saphenous vein-sparing surgery: valvuloplasty combined with axial transposition of a competent tributary vein for the treatment of primary valvular incompetence---18-month follow-up.

BACKGROUND: The greater saphenous vein (GSV) is one of the best grafts for vascular reconstruction, and a variety of sparing methods in patients with primary varicose veins have been performed. Of these, valvuloplasty of the subterminal valve is useful, but reflux in the proximal GSV via a competent tributary vein still remains. To minimize the subsequent reflux, we propose a new method, "valvuloplasty combined with axial transposition of a competent tributary vein" for the treatment of GSV incompetence. OBJECTIVE: To compare this new method with single valvuloplasty. METHODS: Seventy-eight limbs in 65 patients with GSV incompetence were included. Of these limbs, 38 underwent angioscopic valvuloplasty of the subterminal valve alone (V group). The remaining 40 were treated by angioscopic valvuloplasty combined with axial transposition of a competent tributary vein (V + T group). A competent tributary vein was identified by duplex scan in the thigh before surgery. After angioscopic valvuloplasty had been done, a competent tributary vein was exposed, and was cut 1.5 cm distal to its insertion. The distal cut end of the vein was then transposed to the GSV and end-to-side anastomosis was performed using 8-0 nylon under magnification. The incompetent GSV was ligated between the insertion and the anastomosed region. Venous hemodynamic changes were analyzed using air plethysmography (APG). Values obtained by9 APG included venous volume (VV), venous filling index (VFI), ejection fraction (EF), and residual venous function (RVF). The follow-up period was 18 months. Intergroup differences were analyzed with the Wilcoxon ranked sum test for nonparametric distribution. RESULTS: There were no statistical differences in age, gender, or clinical presentation between the two groups. In the V group, 27 limbs had reflux in the proximal GSV (67.4%). On the other hand, only 6 limbs (13.3%) showed minor reflux in the V + T group. A significant difference was seen in VFI at 1 year, and a continuous increase was observed in the V group during the follow-up examinations (P =.0035, VFI = 2.50 plus minus 1.21, 1.14 plus minus 0.42 at 18 months, respectively). CONCLUSION: Valvuloplasty combined with axial transposition of a competent tributary vein gives a better result than valvuloplasty alone at the 18-month follow-up. A competent valve in this location can be expected to improve VFI to a normal range.

Adult↗
PubMed2002

Intraoperative angioscopy may improve the outcome of in situ saphenous vein bypass grafting: a prospective study.

OBJECTIVE: To find out whether intraoperative angioscopic assistance has any effect on graft outcome in patients with critical leg ischemia. MATERIAL AND METHODS: One hundred one patients requiring a below-knee bypass were assigned to undergo in situ saphenous vein bypass with or without intraoperative angioscopic assistance; otherwise treated similarly including preoperative duplex vein mapping, intraoperative graft flow measurements, and angiography. Data on operative details, morbidity, hospital stay, and graft patency were collected prospectively and compared. All patients were followed up for 12 months. RESULTS: The group that underwent angioscopy (A) and the control group (B) were similar in all respects, except for the number of patients enrolled in the groups (32 and 69, respectively). Angioscopy revealed incompletely destructed valves in 34 patients (range, 0 to 5; mean 1), undiagnosed vein branches in 111 patients (mean 4.3), and partly occluding thrombus in 5 patients. The number of postoperative arteriovenous fistulas with signs of failing graft and a need for angiographic or surgical reintervention were significantly higher in group B (P <.0001). The 1-year primary patency rate was significantly better in group A (P <.01), but the primary assisted and secondary patency rates did not differ between the groups. CONCLUSIONS: Angioscopic assistance has an impact on primary graft patency, minimizes the risk for graft failure and thus reduces the need for reintervention by allowing identification of persistent saphenous vein branches, incomplete valve destruction, and partly occluding graft thrombus without adding extra operative time.

Aged↗
PubMed1994

The 'Ermenonville' classification of observations at coronary angioscopy--evaluation of intra- and inter-observer agreement. European Working Group on Coronary Angioscopy.

A European coronary angioscopy working group has been established to create and evaluate a classification system for angioscopic observation. The 'Ermenonville' classification features items, graded in 3-5 categories, such as lumen diameter, shape of narrowing, colours of surface, atheroma, dissection, thrombus, etc. Inter- and intra-observer agreement on the interpretation of angioscopic images, using this classification system, was studied within the working group. Kappa values for chance-corrected intra-observer agreement of the diagnostic items were 0.51-0.67. The mean kappa values for inter-observer agreement were very low at 0.13-0.29. The important items, such as red thrombus and dissection were studied after recoding as either present or absent. These items proved to have a good intra-observer agreement, and an acceptable inter-observer agreement after recoding. Other angioscopic diagnoses should be made with caution. Multicentre angioscopy studies should make use of an angioscopy core laboratory. A set of definitions for coronary angioscopy is proposed, and this working group will re-evaluate observer agreements using these definitions.

Angioscopy↗
PubMed1990

Percutaneous coronary angioscopy: methods, findings, and therapeutic implications.

The development and clinical implementation of percutaneous coronary angioscopy represents an engineering triumph, blending the newest technologies and materials in the field of fiberoptics with the most advanced techniques of balloon angioplasty catheter materials and construction. Current devices provide a safe method for acquiring excellent quality images of the coronary arteries. This is due to major advances in catheter alignment techniques allowing coaxial positioning of the angioscope in the relatively tortuous coronary arteries. Additional development is needed to further refine the degree of operator control over the field of view, which would also reduce procedure duration. The percutaneous coronary angioscope is currently a functional device for investigators attempting to correlate the morphology of atherosclerotic lesions and clinical coronary artery disease. Confirmation of the value of the angioscope as a clinically useful device for routine application in the diagnosis and management of cardiovascular disease will depend upon the results of further studies.

Angioplasty, Balloon, Coronary↗