Coronary angioscopy during cardiac catheterization and cardiac surgery
- 26 Downloads
- 5 Citations
Summary
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 (Ø1.2–1.8 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.
Key words
angioscopy cardiac catheterization coronary endoscopy coronary heart diseasePreview
Unable to display preview. Download preview PDF.
References
- 1.Greenstone SM, Shore JM, Heringman EC, Massell TB. Arterial endoscopy (arterioscopy). Arch Surg 1966; 93: 811–812.PubMedGoogle Scholar
- 2.Vollmar JF, Storz LW. Vascular endoscopy. Possibilities and limits of its clinical application. Surg Clin N Amer 1974; 54: 111–122.PubMedGoogle Scholar
- 3.Spears JR, Marais JH, Serur JR, Pomerance O, Geyer RP, Sipzener RS, Weintraub R, Thurer R, Paulin S, Gerstin R, Grossman W. In vivo coronary angioscopy. JACC 1983; 5: 1311–1314.Google Scholar
- 4.Spears JR, Spokojny AM, Marais JH. Coronary angioscopy during cardiac catheterization. JACC 1985; 6: 93–97.PubMedGoogle Scholar
- 5.Litvack F, Grundfest WS, Lee ME, Carroll RM, Foran R, Chaux A, Berci G, Rose HB, Matloff JM, Forrester JS. Angioscopic visualization of blood vessel interior in animals and humans. Clin Cardiol 1985; 8: 65–70.PubMedGoogle Scholar
- 6.Hombach V, Höher M, Hannekum A, Hügel W, Buran B, Höpp HW, Hirche Hj. Erste klinische Erfahrungen mit der Koronarendoskopie. Dtsch Med Wschr 1986; 111: 1135–1140.PubMedGoogle Scholar
- 7.Falk E. Unstable angina with fatal outcome: dynamic coronary thrombosis leading to infarction and/or sudden death: autopsy evidence of recurrent mural thrombosis with peripheral embolization culminating in total vascular occlusion. Circulation 1985; 71: 699–708.PubMedGoogle Scholar
- 8.Friedman M. The coronary canalized thrombus: Prevalence, structure, function and relationship to death due to coronary artery disease. Br J Exp Pathol 1967; 48: 556.PubMedGoogle Scholar
- 9.Forrester JS, Litvack F, Grundfest W, Hickey A. A perspective of coronary disease seen through the arteries of living man. Circulation 1987; 75: 505–513.PubMedGoogle Scholar
- 10.Sherman CT, Litvack F, Grundfest WS, Lee M, Hickey A, Chaux A, Kass R, Blanche C, Matloff J, Morgenstern L, Ganz W, Swan JHC, Forrester JS. Demonstration of thrombus and complex atheroma by in-vivo angioscopy in patient with unstable angina pectoris. N Engl J Med 1986; 315: 913–919.PubMedGoogle Scholar
- 11.Cutler EC, Levine SA, Beck CS. The surgical treatment of mitral stenosis. Experimental and clinical studies. Arch Surg 1924; 9: 689.Google Scholar
- 12.Lee G, Garcia JM, Corso PJ, Chan MC, Rink JL, Pichard A, Lee KK, Reis RL, Mason DT. Correlation of coronary angiocopic to angiographic findings in coronary artery disease. Am J Cardiol 1986; 58: 238–241.PubMedGoogle Scholar
- 13.Litvack F, Hickey A, Grundfest W, Lee M, Sherman T, Doyle L, Chaux A, Blanche C, Kass R, Matloff J, Swan HJC, Forrester JS. Angioscopy is susperior to angiography for detecting complex atheroma. Circulation 1986; 74 (suppl II): II-362. (Abstract).Google Scholar
- 14.Sanborn TA, Rygaard JA, Westbrook BM, Lazar HL, Mc Cormick JR, Roberts AJ. Intraoperative angioscopy of saphenous vein and coronary arteries. J Thoracic Cardiovasc Surg 1986; 91: 339–343.Google Scholar
- 15.Uchida Y, Masuo M, Tomaru T, Kato A, Sugimoto T. Fiberoptic observation of thrombosis and thrombolysis in isolated human coronary arteries. Am Heart J 1986; 112: 691–696.PubMedGoogle Scholar
- 16.Lee G, Ikeda RM, Stobbe D, Ogata C, Theis J, Hussein H, Mason DT. Laser irradiation of human atherosclerotic obstructive disease. Simultaneous visualization and vaporisation achieved by a dual fiberoptic catheter. Am Heart J 1983; 105: 163–164.PubMedGoogle Scholar
- 17.Lee G, Ikeda RM, Chan MC, Lee MH, Rink JL, Reis RL, Theis JH, Low R, Bommer WJ, Kung AH, Hanna ES, Mason DT. Limitations, risks and complications of laser recanalization. A cautious approach warranted. Am J Cardiol 1985; 56: 181–185.PubMedGoogle Scholar
- 18.Hombach V, Höher M, Arnold G, Osypka P, Kochs M, Eggeling T, Höpp HW, Hirche Hj, Hilger HH. Die Hochfrequenzangioplastie — eine neue Methode zur Rekanalisation verschlossener arterieller Gefäße. CorVas 1987; 2: 67–73.Google Scholar