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PubMed2003

[Intravascular ultrasound and angioscopy].

We observed pulmonary artery thrombi and parietal lesions in patients with acute pulmonary thromboembolism (APTE), using intravascular ultrasound (IVUS) and angioscopy (AS). In APTE without underlying disease mainly non-echorich intraluminal mass was noted, with a pulsatile and thin intima. On AS red thrombi with white fibrin coating could be directly observed, and no parietal lesions were found. The findings of the pulmonary arterial intima and thrombus were different between APTE and chronic pulmonary thromboembolism (CPTE), and even among CPTE cases. IVUS and AS are useful in characterizing the thrombi and related pulmonary artery lesions in PTE.

Acute Disease↗
PubMed1994

[Renal angioscopy].

Presentation as a novelty of the application of endoscopic methods in the display of the renal artery (angioscopy). Review of findings seen in the renal artery of a donor corpse with polytraumatism using direct view with a MiniScope-type rigid urethroscopy and the possible future application of this technique.

Angioscopy↗
PubMed1995

[Coronary angioscopy: initial experience during coronary interventions].

BACKGROUND AND OBJECTIVE: Percutaneous coronary angioscopy (CAG) provides in vivo visual information about the luminal aspect of the vessel. In this report we describe our initial experience with CAG during coronary angioplasty (PTCA). METHODS: Fifty-five patients (age 60 +/- 9 years), 8 female, were included. Most patients, 42 (76%) were treated for unstable angina. RESULTS: In 49 patients (89%) CAG was performed prior to PTCA, and in all cases the intraluminal material responsible of the stenosis was recognized. This included plaque associated to thrombus in 29 patients (59%), isolated plaque in 15 (31%) and isolated thrombus in 5 (10%). Of these plaques, 25 (57%) were yellow, 14 (32%) were yellow and white and 5 (11%) were white. Of the 34 thrombi, 23 (68%) were mural and 11 (32%) protruding. CAG post-PTCA was performed in 43 patients (78%). CAG visualized residual plaque in 41 patients (95%) and residual thrombus in 34 (79%). In addition, CAG recognized dissections in 30 patients (70%). CAG was more sensitive than angiography for the detection of thrombus (pre-PTCA 34 [69%] vs 11 [22%]; p < 0.05, and post-PTCA 34 [79%] vs 5 [12%]; p < 0.05]) and coronary dissections (post-PTCA 30 [70%] vs 19 [44%]; p < 0.05). CAG before intervention caused angina in 39 patients (80%), ventricular fibrillation (successfully managed with DC cardioversion) in 1, and AV block in another patient. The angiographic result deteriorated in 4 patients (9%) immediately after the CAG performed following PTCA. A repeat balloon PTCA was required in these patients. CONCLUSIONS: CAG provides unique information on coronary lumen surface that complements angiographic data. As compared with angiography, CAG is more sensitive in the detection of intracoronary thrombi and dissections. Further studies are required to determine whether the additional information provided by CAG may be used, to select coronary interventions according to specific lesion characteristics, to optimize dilation results and, eventually, to improve the clinical outcome of these patients.

Aged↗
PubMed1997

[Use of angioscopy in vascular surgery bypass with an in situ approach--first year experience].

Femoropopliteal and femorocrural bypass, managed by "in situ" procedure with the use of angioscope, became a standard surgical method in the treatment of occlusive process in the arteries of lower extremities in the Department of Vascular Surgery, Clinical Hospital "Sestre milosrdnice" in Zagreb. The capabilities of angioscopy in diagnosis and in surgery are presented, with special emphasis on bypass "in situ" procedure. Technical difficulties encountered in bypass formation and our solutions are described. From December 1993 to December 1994, eleven patients were operated. Common femoral artery was used for proximal anastomosis in four patients. Superficial femoral artery was used in five patients, and profound femoral artery was used in two patients. The third segment of popliteal artery was used for distal anastomosis in five cases. In six cases crural bypass was done. Three of them were on posterior tibial artery, two were on fibular artery and one was on anterior tibial artery. Two out of four or 50% of femoropopliteal bypasses are patent after the first year. One patient died of cardiorespiratory complications in the early postoperative period. Femorocrural bypasses are patent in five out of six patients or 83.3%. Bypass with great saphenous vein "in situ" is the procedure of choice, especially in femorocrural position.

Aged↗
PubMed1997

[The role of non-angiographic observations (IVUS, angioscopy, doppler) in coronary stenting].

Coronary stenting is increasingly used during transcatheter coronary therapy. Coronary angiography, mainly since the advent of quantitative angiography, provides an effective tool to obtain excellent clinical results with coronary stenting. However, during this procedure some limitations inherent to the angiographic techniques may become apparent. Accordingly, great enthusiasm has been generated regarding the potential value of alternative diagnostic techniques to guide coronary stenting. Intravascular ultrasound is able to study the arterial wall and provides a unique tool to assess stent expansion, apposition and symmetry. Therefore, this technique is increasingly used to optimize stent deployment. Coronary angioscopy directly visualizes stent expansion and is able to precisely recognize protrusion of redundant fronds of tissue or residual dissections within the stent struts. In addition, this technique is the procedure of choice to identify intracoronary thrombus. Intracoronary Doppler permits the application in the catheterization laboratory of sophisticated methods of functional assessment of lesion severity. Coronary stenting allows a faster and complete normalization of coronary flow reserve than balloon angioplasty. Thus, all these new techniques of intracoronary diagnosis provide unique and useful information, which is complementary to that obtained with angiography, potentially useful during coronary stenting.

Angioscopy↗
PubMed1998

[Value of intravascular ultrasound and angioscopy for diagnosis and prediction of acute coronary syndrome].

The new catheter-based imaging modalities of intravascular ultrasound(IVUS) and angioscopy(AS) can provide with morphologic information within a vessel wall or on an intimal surface of coronary artery, which cannot be clarified by conventional angiography. They could demonstrate some evidences of coronary plaque rupture after the onset of acute coronary syndrome (ACS). IVUS showed an intimal flap and an echolucent area behind it, which might represent a fibrous cap and a lipid core, respectively. Also, AS revealed an intimal tear in various grades. IVUS and AS may contribute to detect a "vulnerable coronary plaque." Both findings of an eccentric fibrofatty plaque, sometimes with an echolucent area, demonstrated by IVUS and a yellow plaque revealed by AS may be valuable for prediction of the plaque rupture preceding ACS.

Acute Disease↗
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↗
PubMed1991

Percutaneous fiberoptic angioscopy of the cardiac valves.

The feasibility of percutaneous translumial angioscopy of the cardiac valves was examined in eight patients with and in 11 patients without valvular disease. In eight of these patients, a guiding balloon catheter (9F) was introduced into the aortic root, a guide wire (0.014 or 0.025 inch) was introduced through the catheter into the left ventricle to prevent dislocation of the catheter, and a fiberscope (1.6 or 4.6F) was advanced to the distal tip of the catheter. The balloon was then inflated with carbon dioxide and was manipulated against the aortic valve; a body temperature heparinized saline was infused through the catheter for observation. Similarly, the balloon catheter was advanced transseptally into the left atrium for observation of the mitral valve in four patients. Also, the balloon catheter was advanced through the right femoral vein into the right atrium for observation of the tricupid valve in three patients. In patients with a normal aortic valve, the aortic cusp surface was smooth and white and the edges were sharp. They opened briskly during systole and coapted each other completely during diastole. In rheumatic aortic regurgitation, the cuspus were thick and blunt and their coaptation insufficiency was observed during diastole. In a patient with rheumatic AS, globular and yellow cusps were observed. Mitral valve leaflets were smooth and white in a patients without mitral valvular disease, while the leaflets were yellow, thick and irregular, and blood regurgitation from the left ventricle into the left atrium could be observed in two patients with rheumatic MSR. The process of opening and closure of a tricuspid valve was also observed in three patients without tricuspid valvular disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1986

Video angioscopy as an alternative to intraoperative arteriography.

Improved technology has made available the technique of video angioscopy. When applied routinely, it can provide a high yield of important technical detail in a graphically precise and easily applicable manner, at the time of a great variety of vascular reconstructions, and complications are rare. Although not entirely replacing intraoperative arteriography, its multiple attractive characteristics make it substantially more useful in many circumstances. Familiarity with the technique will enable vascular surgeons to more rapidly utilize new methods of therapy, such as lasers, as well as improve already existing ones.

Angiography↗
PubMed1983

In vivo coronary angioscopy.

The feasibility of in vivo coronary angioscopy was tested utilizing a 1.8 mm angioscope in vessels where blood had been replaced by optically clear liquids, including a new perfluorocarbon emulsion. After trials in postmortem canine and human coronary arteries, in vivo intraluminal visualization was accomplished in the dog with a catheterization technique and in patients during open heart surgery. The results demonstrate the feasibility and potential clinical usefulness of direct visualization of intravascular anatomy and disease, analogous to endoscopy of other organ systems.

Animals↗
PubMed1992

Angioscopy: a new light on peripheral vascular disease.

Although fibre-optic imaging has been used in a number of medical specialties for several years, it has only recently begun to develop in the area of peripheral vascular disease. This review considers the historical development of angioscopy, its current role in peripheral vascular surgery and, finally, its potential for the future.

Angioplasty, Balloon↗
PubMed1988

Usefulness of angioscopy in stenotic processes of the carotid--a comparison with morphological findings.

The development of a new generation of ultrathin flexible fiberscopes permitted direct in-vivo intravascular visualization of pathological changes. But not until the construction of a double-lumen balloon catheter for simultaneous obstruction of the blood flow and rinsing of the vessel did an accurate percutaneous transluminal examination become possible. For testing the usefulness of angioscopic intraluminal diagnosis, 48 carotid arteries from 32 autopsies were examined independently by angioscopy and morphologically. There was a high degree of correspondence between the two methods, especially in cases with low-degree stenosis or complicated plaques, in which other examination methods often fail. Problems of underestimating fibrous plaques and optical projection upstream of the stenosis are discussed.

Arterial Occlusive Diseases↗
PubMed1994

Angioscopy-guided placement of balloon-expandable stents in the treatment of experimental carotid aneurysms.

This study was designed to assess the efficacy of a metallic, rigid, balloon-expandable stent (Palmaz-Schatz) for occlusion of an aneurysm. First, a glass model of two types of aneurysms was constructed, one simple lateral aneurysm and one lateral aneurysm with a side branch. After placement of the stent, the flow towards the distal, post-aneurysmal part of the glass tube was increased with immediate reduction of the flow towards the aneurysm. Beside some turbulences around the struts of the stent there was some inflow of dye into the aneurysm with partial and delayed filling of the aneurysm and delayed washout of the dye from the aneurysm. The same observations could be made with the side-branch aneurysm model. Although parts of the struts involved the ostium of the side branch, there was no flow alteration towards this branch. Second, 10 experimentally constructed aneurysms of the carotid artery in beagles were treated with stents. These stents were placed transfemorally and, since the stents were barely visible under fluoroscopy, angioscopy was performed before and after stenting in order to improve positioning of the stent. In 8 out of 10 cases placement of the stent resulted in an immediate complete occlusion of the aneurysm with remaining patency of the carotid artery. In the other 2 cases, a delayed, but complete occlusion was achieved. In one case, the carotid artery was completely occluded at a follow-up angiography after two weeks, probably induced by intimal damage during insertion of the stent. In two other cases, there was considerable stenosis of the carotid artery due to intimal proliferation.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioscopes↗
PubMedDate not supplied

Angioscopy in transluminal balloon and laser angioplasty in the management of chronic hemodialysis fistulae.

In chronic hemodialysis patients, there is the major problem of occlusion in the arteriovenous fistulae. To investigate this problem, the authors have developed angioscopy for examination and detection of occlusion developing to allow early use of transluminal balloon angioplasty (PTA) or laser angioplasty and prevent occlusions. The authors have examined 27 patients using a 2.7 mm diameter Olympus flexible angioscope and 9F sheath, following-up with a 4 mm balloon catheter (BARD) or SLT Nd-YAG laser. PTA was performed for 25 cases, with 19 demonstrating after one session patency lasting 9 months to date. Three cases revealed restenosis and have each received three PTA sessions. Laser angioplasty was performed in one case of 15 cm chronic occlusion, with subsequent PTA successfully enabling hemodialysis. Angioscopically, the authors were able to observe the various rest-forms within the shunt and detected the mural thrombus attached to the punctured pore. Both circumferential and valvular stenoses were observed. Initially after laser angioplasty, rough irregularity and a mural thrombus in the vessel was observed, but 2 months later, the vessel lumen had become smooth, probably due to intimal growth. Thrombus is acute stenosed cases were clearly observed. Angioplasty enabled new observations in the A-V fistulae, which allows investigation of the mechanism of stenosis or occlusion and enables an extended use of the hemodialysis blood access.

Angioplasty, Balloon↗
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↗
PubMed1990

Comparative studies of angioscopy and ultrasound for the evaluation of arterial disease.

In this in vitro investigation, we studied the histopathological basis for intravascular ultrasound image interpretation and how this technique compares with fiberoptic angioscopy in assessing atherosclerosis. This article presents the sensitivity and specificity of these techniques in the recognition of arterial abnormalities. The relevance of these data in interventional therapeutic procedures and the clinical implications of intravascular imaging methods are also discussed.

Animals↗