The use of coronary angioscopy in diagnosis and clinical decision making

  • Peter den Heijer
Part of the Developments in Cardiovascular Medicine book series (DICM, volume 186)

Summary

Although coronary angioscopy, shortly after its introduction in 1991, seemed promising as a clinical decision tool in interventional cardiology, it has until now mainly been used as a device for clinical research. It is somewhat surprising that this imaging modality proved to be in lack of practical applications. Nevertheless, angioscopy can reliably discriminate unstable from stable lesions, and be of value in the management of threatened acute closure after PTCA or stenting. Its sensitivity and specificity in the detection of intracoronary thrombus is unsurpassed. A new class of drugs, the glycoprotein Ilb/IIIa inhibitors, is presently making a large impact on interventional cardiology. Coronary angioscopy can potentially play an important role in research as well as clinical use of such drugs, because it is essentially the only reliable tool for intracoronary thrombus detection.

Keywords

Unstable Angina Coronary Angioplasty Interventional Cardiology Intracoronary Thrombus White Thrombus 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Ambrose JA, Winters SL, Stern A et al. Angiographic morphology and the pathogenesis of unstable angina pectoris. J Am Coll Cardiol 1985; 5: 609–16.PubMedCrossRefGoogle Scholar
  2. 2.
    De Feyter PJ, Ozaki Y, Baptista J et al. Ischemia-related lesion characteristics in patients with stable or unstable angina. A study with intracoronary angioscopy and ultrasound. Circulation 1995; 92: 1408–13.PubMedGoogle Scholar
  3. 3.
    Mizuno K, Satomura K, Miyamoto A et al. Angioscopic evaluation of coronary-artery thrombi in acute coronary syndromes. N Engl J Med 1992; 326: 287–91.PubMedCrossRefGoogle Scholar
  4. 4.
    Den Heijer P, Foley DP, Hillege HL, et al. The “Ermenonville” classification of observations at coronary angioscopy - evaluation of intra- and inter observer agreement. European Working Group on Coronary Angioscopy. Eur Heart J 1994; 15: 815–22.Google Scholar
  5. 5.
    Knopf WD, Cates CU, Doby B, Langlois K. Coronary angioscopy influences intervention in patients with unstable angina and recent myocardial infarction [abstract]. Circulation 1992; 86(Suppl.1): 1–651.Google Scholar
  6. 6.
    Lablanche JM, Hamon M, McFadden EP, Bauters C, Quandalle P, Bertrand ME. Angiographically silent thrombus frequently persists after thrombolytic therapy for acute myocardial infarction: a prospective angioscopic study [abstract]. Circulation 1993; 88(4 pt 2): I-595.Google Scholar
  7. 7.
    White CJ, Ramee SR, Collins TJ. Percutaneous coronary angioscopy: a tool in clinical decision-making. Choices Cardiol 1994; 8: 53–6.Google Scholar
  8. 8.
    Lineoff AM, Popma JJ, Ellis SG, Hacker JA, Topol EJ. Abrupt vessel closure complicating coronary angioplasty: clinical, angiographic and therapeutic profile. J Am Coll Cardiol 1992; 19: 926–35.CrossRefGoogle Scholar
  9. 9.
    Herrmann HC, Buchbinder M, Clemen MW et al. Emergent use of balloon-expandable coronary artery stenting for failed percutaneous transluminal coronary angioplasty. Circulation 1992; 86: 812–9.PubMedGoogle Scholar
  10. 10.
    De Muinck ED, den Heijer P, van Dijk RB et al. Autoperfusion balloon versus stent for acute or threatened closure during percutaneous transluminal coronary angioplasty. Am J Cardiol 1994; 74: 1002–5.PubMedCrossRefGoogle Scholar
  11. 11.
    Fischman DL, Savage MP, Leon MB et al. Angiographic predictors of subacute thrombosis following coronary artery stenting [abstract]. Circulation 1991; 84(Suppl. II): 11–588.Google Scholar
  12. 12.
    Teirstein PS, Schatz RA, Wong SC, Rocha-Singh K. Coronary stenting with angioscopic guidance. Am J Cardiol 1995; 75: 344–7.PubMedCrossRefGoogle Scholar
  13. 13.
    Nakamura S, Colombo A, Gaglione A et al. Intracoronary ultrasound observations during stent implantation. Circulation 1994; 89: 2026–34.PubMedGoogle Scholar
  14. 14.
    Strumpf RK, Heuser RR, Eagan JT Jr. Angioscopy: a valuable tool in the deployment and evaluation of intracoronary stents. Am Heart J 1993; 126: 1204–10.PubMedCrossRefGoogle Scholar
  15. 15.
    Resar JR, Brinker J. Early coronary artery stent restenosis: utility of percutaneous coronary angioscopy. Cathet Cardiovasc Diagn 1992; 27: 276–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Schatz RA, Baim DS, Leon M et al. Clinical experience with the Palmaz-Schatz coronary stent. Initial results of a multicenter study. Circulation 1991;83: 148–61.PubMedGoogle Scholar
  17. 17.
    Den Heijer P, van Dijk RB, Twisk S, Lie KI. Early stent occlusion is not always caused by thrombosis. Cathet Cardiovasc Diagn 1993; 29: 136–40.CrossRefGoogle Scholar
  18. 18.
    Ryan TJ, Faxon DP, Gunnar RM et al. Guidelines for percutaneous transluminal coronary angioplasty. A report of the American College of Cardiology/American Heart Association Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures (Subcommittee on Percutaneous Transluminal Coronary Angioplasty). Circulation 1988; 78: 486–502.PubMedCrossRefGoogle Scholar
  19. 19.
    Foley DP, Hermans WM, Rensing BJ, De Feyter PJ, Serruys PW. Restenosis after percutaneous transluminal coronary angioplasty. Herz 1992;17: 1–17.PubMedGoogle Scholar
  20. 20.
    Ferns GA, Stewart-Lee LA, Anggard EE. Arterial response to mechanical injury: balloon catheter de-endothelialization. Atherosclerosis 1992; 92: 89–104.PubMedCrossRefGoogle Scholar
  21. 21.
    Harrison DG. Endothelial modulation of vascular tone: relevance to coronary angioplasty and restenosis. J Am Coll Cardiol 1991; 17(6 Suppl.B): 71B–76B.PubMedCrossRefGoogle Scholar
  22. 22.
    Liu MW, Roubin GS, King SB 3rd. Restenosis after coronary angioplasty: Potential biologic determinants and role of intimal hyperplasia. Circulation 1989; 79: 1374–87.PubMedCrossRefGoogle Scholar
  23. 23.
    Kuntz RE, Safian RD, Levine MJ, Reis GJ, Diver DJ, Baim DS. Novel approach to the analysis of restenosis after the use of three new coronary devices. J Am Coll Cardiol 1992; 19: 1493–9.PubMedCrossRefGoogle Scholar
  24. 24.
    Umans VA, Beatt KJ, Rensing B, Hermans WR, De Feyter PJ, Serruys PW. Comparative quantitative angiographic analysis of directional coronary atherectomy and balloon coronary angioplasty. Am J Cardiol 1991; 68: 1556–63.PubMedCrossRefGoogle Scholar
  25. 25.
    White CW, Chaitman B, Knudtson ML, Chisholm RJ. Antiplatelet agents are effective in reducing the acute ischemic complications of angioplasty but do not prevent restenosis: Results from the ticlopidine trial. Coron Artery Dis 1991; 2: 757–67.Google Scholar
  26. 26.
    Serruys PW, Rutsch W, Heyndrickx GR et al. Prevention of restenosis after percutaneous transluminal coronary angioplasty with thromboxane A2-receptor blockade. A randomized, double-blind, placebo-controlled trial. Coronary Artery Restenosis Prevention on Repeated Thromboxane-Antagonism Study (CARPORT). Circulation 1991; 84: 1568–80.PubMedGoogle Scholar
  27. 27.
    Bairati I, Roy L, Meyer F. Double-blind, randomized, controlled trial of fish oil supplements in prevention of recurrence of stenosis after coronary angioplasty. Circulation 1992; 85: 950–6.PubMedGoogle Scholar
  28. 28.
    Kaul U, Sanghvi S, Bahl VK, Dev V, Wasir HS. Fish oil supplements for prevention of restenosis after coronary angioplasty. Int J Cardiol 1992;35: 87–93.PubMedCrossRefGoogle Scholar
  29. 29.
    Margolis JR, Mehta S. Excimer laser coronary angioplasty. Am J Cardiol 1992; 69: 3F–11F.PubMedCrossRefGoogle Scholar
  30. 30.
    Serruys PW, De Jaegere P, Kiemeneij F et al. A comparison of balloon-expandable-stent implantation with balloon angioplasty in patients with coronary artery disease. Benestent Study Group. N Engl J Med 1994;331: 489–95.PubMedCrossRefGoogle Scholar
  31. 31.
    Fischman DL, Leon MB, Baim DS et al. A randomized comparison of coronary-stent placement and balloon angioplasty in the treatment of coronary artery disease. Stent Restenosis Study Investigators. N Engl J Med 1994;331: 496–501.PubMedCrossRefGoogle Scholar
  32. 32.
    Den Heijer P, van Dijk RB, Hillege HL, Pentinga ML, Serruys PW, Lie KI. Serial angioscopic and angiographic observations during the first hour after successful coronary angioplasty: a preamble to a multicenter trial addressing angioscopic markers for restenosis. Am Heart J 1994; 128: 656–63.CrossRefGoogle Scholar
  33. 33.
    Bauters C, Lablanche JM, McFadden EP, Hamon M, Bertrand ME. Relation of coronary angioscopic findings at coronary angioplasty to angiographic restenosis. Circulation 1995; 92: 2473–9.PubMedGoogle Scholar
  34. 34.
    Coller BS. A new murine monoclonal antibody reports an activation dependent change in the conformation and/or microenvironment of the platelet glycoprotein Ilb/IIIa complex. J Clin Invest 1985;76: 101–8.PubMedCrossRefGoogle Scholar
  35. 35.
    Use of a monoclonal antibody directed against the platelet glycoprotein Ilb/IIIa receptor in high-risk coronary angioplasty. The EPIC Investigators. N Engl J Med 1994; 330: 956–961.Google Scholar
  36. 36.
    Den Heijer P, Foley DP, Escaned J et al. Angioscopic versus angiographic detection of intimal dissection and intracoronary thrombus. J Am Coll Cardiol 1994; 24: 649–54.CrossRefGoogle Scholar
  37. 37.
    Uretsky BF, Denys BG, Counihan PC, Ragosta M. Angioscopic evaluation of incompletely obstructing coronary intraluminal filling defects: comparison to angiography. Cathet Cardiovasc Diagn 1994;33: 323–9.PubMedCrossRefGoogle Scholar

Copyright information

© Kluwer Academic Publishers 1996

Authors and Affiliations

  • Peter den Heijer

There are no affiliations available

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