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PubMed1992

[Angioscopic findings of the peripheral pulmonary arteries in patients with chronic pulmonary diseases].

Angioscopic observation of the peripheral pulmonary arteries was performed in 14 patients with chronic lung diseases (male 9/female 5, age 70.8 +/- 8.3 years, pulmonary tuberculosis sequelae 6, chronic bronchitis 4, chronic pulmonary emphysema 3, pneumoconiosis 1). The blood flow was stopped by the inflated balloon of a 7F guiding catheter, and then the peripheral pulmonary arteries (inner diameter 1.0-4.5 mm) were observed with a fiberoptic catheter (outer diameter 0.7 mm). In 10 out of 14 patients abnormal findings were obtained, which included redness, erosion, ulceration of the vascular wall, thrombus, fibrous tissue, and occlusion of the lumen. The incidence of abnormal findings tended to be higher in chronic bronchitis and pulmonary tuberculosis sequelae than in chronic pulmonary emphysema. These results suggest that 1) various changes including "vasculitis" and thrombus exist in the peripheral pulmonary arteries of chronic lung diseases, and 2) that angioscopy may provide the detailed information about both the vascular wall and the lumen which cannot be obtained by pulmonary angiography.

Aged↗
PubMed2006

Angioscopically-determined extent of coronary atherosclerosis is associated with severity of acute coronary syndrome.

OBJECTIVE: Some patients with acute coronary syndrome (ACS) have large myocardial infarction but others have small or no infarction. However, what makes this difference has not been clarified. We compared the angioscopic findings between those two categories of ACS patients and examined the association between the severity of ACS and the morphology of both culprit lesion and nonculprit coronary segments. METHODS: Prospectively and consecutively enrolled patients with ACS were classified as CK-elevation-ACS (CKE-ACS; n = 54) or non-CK-elevation-ACS (NCKE-ACS; n = 22). Patients were diagnosed as CKE-ACS when the elevation (greater than twice the normal upper limit) of CK-MB was detected; otherwise, patients were diagnosed as NCKE-ACS. They all underwent emergent catheterization and PCI of the culprit lesion. The entire culprit artery was observed by angioscopy, and the prevalence of thrombus and the color grade of yellow plaques were evaluated. The color grade of yellow plaques were classified as 0 (white), 1 (slight yellow), 2 (yellow), or 3 (intense yellow) according to the standard colors. The color grade of culprit plaque (CC), number (NP) and maximum (MC) color grade of yellow plaques in the nonculprit segments, plaque index (PI = N x MC), and prevalence of thrombus at the culprit lesion (CT) and in the nonculprit segments (NT) were compared between CKE-ACS and NCKE-ACS patients. RESULTS: CC (1.9 +/- 0.9 vs. 1.7 +/- 0.8; p = 0.3) and CT (93% vs. 77%; p = 0.06) were not significantly different between CKE-ACS and NCKE-ACS patients, however, NP (2.2 +/- 1.6 vs. 1.4 +/- 1.2; p = 0.03), MC (1.8 +/- 0.9 vs. 1.2 +/- 0.9; p = 0.008), PI (4.8 +/- 4.4 vs. 2.4 +/- 3.1; p = 0.03), and NT (39% vs. 11%; p = 0.02) were significantly higher in CKE-ACS than in NCKE-ACS patients. CONCLUSION: Although the culprit lesions of CKE- and NCKE-ACS had similar yellow color grades, the culprit lesions of CKE-ACS showed a trend towards a higher prevalence of thrombus. A greater number of yellow plaques of higher color grades and a higher prevalence of thrombosis in the nonculprit segments were detected in CKE-ACS compared to NCKE-ACS patients. The angioscopically-determined extent of coronary atherosclerosis appeared advanced in CKE-ACS patients compared to NCKE-ACS patients.

Acute Disease↗
PubMed2006

[Current status and perspectives of coronary imaging for patients with diabetes mellitus].

Diabetes mellitus (DM) is an independent and distinct risk factor of ischemic heart disease. Therefore, early identification and management of coronary atherosclerosis for patients with DM is being desired. For the purpose of visualizing coronary atherosclerosis, various imaging modalities have been proposed especially to identify an unstable plaque that has a thin fibrous cap and a large lipid core. These modalities include intravascular ultrasound, coronary angioscopy, intracoronary thermography, optical coherence tomography, multi-slice CT, MRI, and so on. The development of these modalities are now pushing all cardiologists to get interested in a new field called as "plaque imaging".

Angioscopy↗
PubMed1994

[Assessment of the results during and after coronary recanalization procedures].

PTCA and new-device angioplasty have dramatically altered the management of patients with symptomatic coronary artery disease. Concurrent with the technical improvement in coronary angioplasty, the methods used to evaluate procedural outcome during and after revascularization have also become more sophisticated. Quantitative coronary angiography, angioscopy, and intravascular ultrasound are the most important methods for decision making, monitoring the procedure and document the final results. However despite their overall research value, these qualitative and quantitative techniques may be of limited value to the clinical interventional cardiologist and are often complementary or redundant. If a choice of these techniques is necessary, on-line quantitative coronary angiography, and intravascular ultrasound are certainly the most helpful methods in a Cath Lab to evaluate procedural outcome.

Angioplasty, Balloon, Coronary↗
PubMed1994

[Superficial femoral vein valvuloplasty under direct angioscopic vision].

Superficial femoral vein valvuloplasty (SFV) under direct angioscopic vision without venotomy was designed and performed in 18 patients (20 limbs), suffering from primary SFV valve incompetence and the primary popliteal vein valve insufficiency. The indication of the operation is that the valves developed completely inborn, but with the effects of postnatal pathogenic factors, the leaflets prolapsed and became redundant, irregular diastema between leaflets emerged and the valve-ring dilated. The operation has several advantages: (1) Angioscopy confirms primary venous valve incompetence. (2) The technique precludes venotomy and valve exposure, reducing the rate of postoperative venous thrombosis. (3) The operation eliminates the blindness of kistner's external surgical technique, overcoming its empiricism. The initial clinic use of the technique has shown that it is of excellent short-term effect without complications.

Adult↗
PubMed1993

In situ saphenous vein grafts for femorodistal bypass: evaluation of endoscopically monitored valvulotomy on graft patency.

An overview of a total of 135 in situ femorocrural bypass operations is given. In the operations all grafts were anastomosed distally to the infrapopliteal arteries: to the proximal half of the crural vessels 52 times and to the distal half 83 times. The indication for surgery was critical limb ischaemia. In addition to routine intraoperative angiography, orthograde angioscopy of the graft was carried out to assess the completeness of valvulotomy in 96 patients (group A). In 39 patients (group B) for whom an endoscope was not available, completion angiography was conducted to ensure graft integrity. The two groups were comparable with respect to their composition. On the basis of the endoscopic findings, revisions were performed in 17 patients with incomplete valve ablation in group A, whereas in group B there were no interventions (P < 0.01, chi 2 test). Using life-table analysis, cumulative primary patency rates for groups A and B were 76% and 76% at 30 days, 62% and 44% at 1 year and 43% and 27% at 4 years, respectively. By comparison with the log rank test, a significant difference in patency among both groups could not be established (P = 0.18).

Aged↗
PubMed1993

Imaging technologies in cardiovascular interventions.

New and exciting vascular imaging technologies are assuming increasingly important roles in the management of vascular disease. Non-invasive modalities such as computerized tomography, magnetic resonance imaging and duplex ultrasound supplement the information obtained by invasive techniques including angiography, angioscopy and intraluminal ultrasound. This paper outlines the modern and developing vascular imaging techniques that are rapidly becoming integral components of therapeutic devices as well as advanced diagnostic systems.

Angiography↗
PubMed1996

The ideal guidance imaging system for endovascular interventions.

Endovascular interventions enable a minimally invasive approach to a variety of cardiovascular lesions. Small catheter-based delivery systems have rapidly evolved, diversifying endovascular therapeutic options. Coronary and peripheral vascular occlusive lesions may be amenable to angioplasty dilatation, intravascular stenting and ablation with mechanical atherectomy devices or lasers. New experimental transluminally placed endovascular stented grafts (TPEGs) have demonstrated feasibility for treating aneurysmal arteries, arteriovenous fistulas, and atherosclerotic occlusions. Improvements in imaging systems have provided better resolution of lesions, have improved patient selection and interventional strategy, and are invaluable for precise performance of procedures. The ideal guidance system should provide realtime imaging by a combination of complimentary modalities. These include cinefluoroscopy and contrast angiography, catheter-based intravascular ultrasound and angioscopy.

Angiography↗
PubMed1996

[Clinical experience of laser angioplasty for the peripheral and coronary arterial diseases].

In recent years, laser angioplasty has been widely performed in the world. Since the 1980's we have investigated anigoplasy using Argon laser for patients with peripheral and coronary arterial diseases. This technique aims to open the obstructive arterial lumen. Based on the excellent results of experimental studies, this technique has been clinically applied. Laser angioplasty was carried out in 98 patients with stenotic or occlusive lesions of the peripheral arteries and 10 patients with anginal attack. Argon laser and an optical fiber delivery system with metal tip probe with thermal feedback control system were used for laser angioplasty. This procedure was performed under angioscopic and intravascular ultrasound imaging. Primary clinical success was achieved in 97 (82%) of all 119 lesions, that is, 53 (91%) of 58 in the stenotic lesions and 44 (72%) of 61 in the occlusive lesions. There were no complications required emergency operation. At 95 months of follow-up, the cumulative patency rate was 80% in 83 limbs with primary success. In the 43 stenoses and 40 occlusions, the cumulative patency rare were 87% and 71%, respectively. On the other hand, laser was simultaneously applied at the time of operation for 10 patients with anginal attack in addition to coronary artery bypass grafting. Thus, laser angioplasty was safe and effective to increase the initial success rate for the lesions that were difficult to treat by balloon anigoplasty. Angioscopy and intravascular ultrasound imaging were useful for the observation of the newly recanalized channel by lasing and selection of the recanalization technique, such as laser angioplasty, atherectomy and stent, according to the characterization of the lesions. These results suggested that laser angioplasty might be a useful treatment for patients with chronic peripheral arterial occlusion and improve the long-term patency rate by eliminating restenosis more than conventional balloon angioplasty.

Adult↗
PubMedDate not supplied

Implantation and imaging of coronary stents.

Percutaneous transluminal coronary angioplasty (PTCA) often is supplemented by the insertion of stents to prevent closing of the coronary arteries. This article reviews types of coronary stents and discusses the role that diagnostic imaging plays in their correct placement and determining their patency following implantation. The four primary diagnostic techniques used to image coronary stents--angiography, ultrasound, computed tomography and angioscopy--are discussed, along with the advantages and limitations of each.

Angioplasty, Balloon, Coronary↗
PubMed1996

Sapheno-femoral valves. Histopathological observations and diagnostic approach before surgery.

BACKGROUND: Since the literature indicated that in the early stages of primary venous disease valves are simply dilated, some authors performed external valvuloplasty of deep and superficial venous valves with encouraging results, although some failures were observed without being sufficiently explained. OBJECTIVE: To obtain further interpretations of the natural history of venous valve pathology, clarify methods for a correct diagnostic approach, and provide indications for the external valvuloplasty procedure. METHODS: Forty-two proximal valves of the long saphenous vein removed for varicose veins of the lower limbs were studied with optical microscopy. The relationship between histologic alterations and age of varicose disease was investigated. Five valvuloplasties were explanted for recurrent reflux and submitted to histopathological observation. Preoperative echographic findings and histologic observations were compared. Nineteen limbs were subjected to external valvuloplasty under angioscopic control; preoperative echographic findings and angioscopic observations were compared. RESULTS: The histologic alterations observed in venous valves were mainly hypotrophy of cusps, which seemed to be the main cause of failure after external valvuloplasty. The frequency of such hypotrophic alterations increases with the age of varicose disease but no statistically significant relationship was found. Preoperative echographic imaging of venous valves does not appear sufficiently predictive when compared with histologic and angioscopic examinations. CONCLUSION: Hypotrophic valve damage seems to be prevalent in patients with varicose veins of the lower limbs. Valve cusp hypotrophy may be present in early disease though some normal cusps can be found in advanced disease. When preoperative echographic visualization of cusps is doubtful, intraoperative angioscopy plays the main role in the diagnosis of venous valve disease before and during external valvuloplasty.

Angioscopy↗
PubMed1998

Invasive strategies to discriminate stable and unstable coronary plaques.

Unstable coronary plaques with surface erosion and plaque rupture lead to acute coronary thrombosis, unstable angina pectoris and myocardial infarction. The in-vivo detection of plaque instability by angiography, intravascular ultrasound or angioscopy or by newly developed techniques, such as optical coherence tomography or by the observation of local temperature increases, offers the opportunity for deeper understanding of the mechanisms underlying plaque rupture and erosion. Pharmacological and transcatheter therapy might be directed more exclusively to unstable plaques, once more detailed knowledge about pathophysiological mechanisms as well as direct information about the individual plaque being treated is available.

Angioscopy↗
PubMed1998

[Video endoscopy in neurosurgery].

The authors present an analysis of their experiences with performing more than 330 video endoscopic operations on the autopsy material and in 172 patients. In 54 of these patients operations were performed for traumatic intracranial convex hematomas, in 21 for adenomas of the hypophysis, in 14--for arterial aneurysms, and 53 patients with discogenic radiculitis, spinal tumors, consequences of severe spinal traumas. In 25 patients the endoscopic videomonitoring was made during excision of the tumors, paratumorous cysts and abscesses of the brain, decompression of the optic nerve, plasty of the anterior cranial fossa fundus with closing the liquor fistulas. Intraoperative angioscopy in carotid endarterectomy was fulfilled in 5 patients. The video endoscopy was proved to result in less traumaticity of the radical surgery. It is a valuable and highly informative method giving optimum results in performing many microsurgical operations.

Adult↗
PubMed1988

Hemangiomalike masses of the retina.

We have followed five patients, each of whom had a solitary unilateral vascular mass of the sensory retina. The lesions were white or pink and often had hemorrhage and exudate on their surface or surrounding area. They appeared to be acquired, as three of the five patients were specifically noted to have normal fundi at some time before presentation. Fluorescein angiography and angioscopy demonstrated the masses to be composed of numerous vessels supplied by the retinal circulation. Slow growth was documented in one patient. Visual loss was variable and was due to leakage-related complications, including exudative detachment, recurrent vitreous hemorrhage, and cystoid macular edema. Four patients were treated with cryopexy, and in all four, this successfully caused involution of the lesions. Two patients had improvement in vision after treatment: one had stabilization, and one had deterioration. This report provides support for the existence of a distinct entity that we have called hemangiomalike mass of the retina, since no histopathologic evidence is yet available (to our knowledge). It also supports the use of judicious cryopexy to lesions associated with visual loss.

Adult↗
PubMed1996

Treatment of no-reflow in degenerated saphenous vein graft interventions: comparison of intracoronary verapamil and nitroglycerin.

No-flow has been reported after 10-15% of percutaneous interventions on degenerated saphenous vein grafts. In this prospective study of 36 degenerated saphenous vein graft lesions (32 patients), no-flow (TIMI flow < 3 in the absence of a significant lesion or dissection) occurred in 15/36 (42%) lesions. A total of 32 episodes of no-flow occurred after angioscopy (n = 14), extraction atherectomy (n = 10), balloon angioplasty (n = 2) or stent implantation (n = 6). Intragraft nitroglycerin (100-300 micrograms) alone resulted in no improvement in TIMI flow in the setting of no-reflow (TIMI flow 1.2 +/- 0.6 to 1.4 +/- 0.8, P = NS). Intragraft verapamil (100-500 micrograms) resulted in improvement in flow in all 32 episodes (TIMI flow 1.4 +/- 0.8 before, to 2.8 +/- 0.5 after verapamil, P < 0.001). Although verapamil increased TIMI flow after all episodes of no-reflow, two (6.3%) had persistent no-reflow (TIMI 1) despite verapamil, associated with non-Q wave myocardial infarction. In conclusion, treatment of no-reflow with verapamil during degenerated vein graft interventions was associated with reestablishment of TIMI 3 flow in 88% of cases. In contrast, intragraft nitroglycerin alone was ineffective for reversing no-reflow.

Aged↗
PubMed1994

Angioscopic guided interventions in a saphenous vein bypass graft.

Intracoronary stents appear promising for treatment of focal vein graft lesions, but their use may be limited by the presence of intraluminal thrombus. This report describes the use of percutaneous coronary angioscopy to identify the presence or absence of intraluminal thrombus and to guide interventional therapy with transluminal extraction coronary atherectomy (TEC) and stenting in a patient with a complex vein graft stenosis.

Atherectomy, Coronary↗
PubMed1987

Mesenteric artery embolization by an unsuspected aortic tumor: diagnostic evaluation and operative management.

Malignant tumor embolus recovered at the time of superior mesenteric artery embolectomy is an uncommon experience. A report of such a case is presented and the literature is reviewed. In this clinical setting, guidelines for further diagnostic evaluation are not well defined. We suggest an algorithm for the evaluation and management of these patients. In the near future, use of intraoperative angioscopy and the intravascular laser to eradicate the tumor may represent the optimal method of treatment.

Algorithms↗
PubMed1989

Early and recent intraluminal ultrasound devices.

The history of intraluminal echography dates back to the very beginning of diagnostic ultrasound. Over the years many fascinating ideas and applications of catheter tip or gastroscopic tube tip mounted transducers have been described. This chapter surveys these methods, subdividing them into a) measurements; b) Doppler and c) imaging. The survey ranges from early work of Cieszynski on the feasibility of echocardiography to more recent intra-arterial catheter tip Doppler with guidewire and balloon as described by Serruys. Examples of ultrasound catheter tip echography in combination with other techniques such as angioscopy, laser ablation and spark erosion are also described. Today practical approaches are limited to imaging only. The three major approaches for catheter tip echo imaging are described and compared. This paper concludes with the results of automatic contour analysis of the inner arterial boundaries.

Cardiac Catheterization↗