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Coronary angioscopy: a monorail angioscope with movable guide wire.

A new angioscope was devised for easier visualization of the coronary artery. In its tip, the angioscope (Olympus) with an outer diameter of 0.8 mm had a metal lumen, through which a 0.014-in steerable guide wire passed. Using a 8F guiding catheter and a guide wire, it was introduced into the distal coronary artery. With injection of warmed saline through the guiding catheter, the coronary segments were visualized. In the attempted 70 vessels (32 left anterior descending [LAD], 10 right coronary [RCA], 28 left circumflex [LCX]) from 48 patients, 60 vessels (86%) were successfully examined. Twenty-two patients who underwent attempted examination of both LAD and LCX; both coronary arteries were visualized in 19 patients (86%). In the proximal site of the lesion, 40 patients have the diagonal branch or the obtuse marginal branch. In 34 patients (85%) the angioscope was inserted beyond these branches. In 12 very tortuous vessels, eight vessels (67%) were examined. In conclusion, the new monorail coronary angioscope with movable guide wire is useful to examine the stenotic lesions of the coronary artery.

Angioplasty, Balloon, Coronary↗

[Coronary angioscopy in ischemic heart disease].

The validity of coronary angioscope was discussed in several clinical settings in this article. First of all, although smooth coronary surface was observed by coronary angiography after the intervention of chronic total occlusion, protrusion or thrombus observed by angioscope occupied the arterial lumen and closed the vessel lumen. After implantation of the stent, lumen was widely opened. Serial angioscopic observation revealed that the neointima became thick and non-transparent until 6 months and then became thin and transparent by 3 years after stent implantation. These findings suggested the validity of angioscope in coronary intervention. Second, coronary angioscope revealed the morphologic and pathologic characteristics of culprit lesions in patients with acute coronary syndrome. The thrombus was observed on the yellow plaque in the culprit lesion. The thrombus formed directly over the plaque was mainly white and red thrombus might be formed after the blood flow was disturbed by the white thrombus formed by the platelet aggregation. These findings imply the importance of anti-platelet therapy after acute coronary syndromes. Finally, the angioscope can detect the minimal changes of the plaque formation, progression and rupture, that is, the entire process of the atherosclerosis. The early detection of yellow plaque might be able to intervent mechanically or pharmacologically to prevent its rupture.

Angioscopy↗

[CT virtual angioscopy in the study of thoracic aortic dissection].

PURPOSE: Virtual endoscopy is a technique in which helical-CT and MR data sets are processed by a special software creating a three-dimensional viewing of the inner surface of hollow viscera that simulates the endoscopic view. We report our 2.5-year experience with virtual intraluminal endoscopy (VIE) in the study of the thoracic aorta in patients with aortic dissection and in patients with normal aorta. MATERIAL AND METHODS: From December 1997 to June 2000, CT angiography (CTA) data sets of the thoracic aorta obtained in a series of 43 patients were retrospectively evaluated. Our series included 23 patients with clinical or radiological suspicion of aortic dissection and 20 patients in whom the study of the thoracic aorta was carried out as a necessary completion of an abdominal aortic disease. CTA data sets were processed with a dedicated software (Navigator); the view point and view direction could be set arbitrarily in the vessel, obtaining an intraluminal endoscopic view of the inner surface of the vessel. Multiple views were obtained and visualised consecutively through a cine-loop technique. The entire thoracic aorta was studied. RESULTS: VIE enabled correct visualisation of the intimal flap in all cases of aortic dissection (=23) and of its origin at the level of the ascending aorta in 16 cases (Stanford A) and in the descending aorta in the remaining 7 patients (Stanford B). In the control group (=20) no signs of intimal flap were identified with the VIE. In all patients with aortic dissection false and true lumen were entirely visualised. VIE allowed the understanding of the relation between false lumen and supraaortic vessels that originated from the true lumen in all cases and were found to be dissected in 6 patients. In 16 cases the dissection included thoracic and abdominal aorta. In some cases the endoscopic view was altered by artifacts related to the selected threshold levels and represented by pierced surface and floating shape artifacts. A correlation with axial and multiplanar (MPR) images allowed the correct interpretation of such artifacts. CONCLUSIONS: According to our experience, virtual endoscopy represents a useful tool in the evaluation of the dissection of the thoracic aorta, allowing a better definition of anatomical details. A correlation with axial images and multiplanar views remains compulsory for a better understanding of VIE findings, which is nevertheless significantly influenced by the operator's experience.

Aortic Dissection↗

Renal angioscopy.

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Accidents, Traffic↗