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Komatsu S, Takewa M, Santo S, Yutani C, Murayama H, Takahashi S, Iwa N, Ohara T, Yoshida A, Kodama K. Cholesterol Crystal Embolization Exacerbates Critical Limb Ischemia. Cureus 2024; 16:e59498. [PMID: 38707758 PMCID: PMC11063808 DOI: 10.7759/cureus.59498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2024] [Indexed: 05/07/2024] Open
Abstract
Chronic life-threatening ischemia (CLTI), characterized by chronic severe ischemic ulcers or gangrene in the legs with arterial occlusive disease, has a high rate of amputation and mortality. However, how lower extremity artery disease (LEAD) leads to CLTI is not fully understood yet. Here, we report a 79-year-old man with resting pain and gangrene in the left first and fifth toes for a year who had undergone repetitive endovascular treatment (EVT) that temporarily improved the ischemia. Non-obstructive general angioscopy (NOGA) revealed yellow and red floating emboli at the occluded left superficial femoral artery (SFA). Although a second EVT for the reoccluded SFA was successful, amputation of the left lower knee remained necessary because of osteomyelitis of the left heel. Cholesterol crystals (CCs) associated with innate inflammation were detected in spontaneously ruptured aortic plaques (SRAPs) via aortic screening using the NOGA, in occluded SFAs, and on the surface of the muscle cross-section of the amputated legs via a polarizing microscope. Histopathological analysis demonstrated CCs in small vessels in various stages of patchy necrosis and muscle regeneration. In this case, the process of CC embolization, such as the embolic source of CCs, occlusion in arteries, small arteries, and deposition in muscles, was confirmed in CLTI. CCs are the principal trigger of IL-6 production through the innate inflammatory response in spontaneously ruptured aortic plaques. Mechanical ischemia and chronic inflammation due to embolized CCs may cause chronic limb damage. In this case, the CC embolization might exacerbate CLTI.
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Affiliation(s)
- Sei Komatsu
- Department of Cardiology, Osaka Gyoumeikan Hospital, Osaka, JPN
| | | | - Shigeru Santo
- Department of Orthopedics, Osaka Gyoumeikan Hospital, Osaka, JPN
| | - Chikao Yutani
- Department of Pathology, Osaka Gyoumeikan Hospital, Osaka, JPN
| | | | | | - Nobuzo Iwa
- Department of Pathology, Osaka Gyoumeikan Hospital, Osaka, JPN
| | - Tomoki Ohara
- Department of Cardiology, Osaka Gyoumeikan Hospital, Osaka, JPN
| | - Atsushi Yoshida
- Department of Orthopedics, Osaka Gyoumeikan Hospital, Osaka, JPN
| | - Kazuhisa Kodama
- Department of Cardiology, Osaka Gyoumeikan Hospital, Osaka, JPN
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Miyagawa M, Kojima K, Takahashi K, Nakajima Y, Migita S, Mizobuchi S, Tanaka Y, Fukumoto K, Arai R, Morikawa T, Mineki T, Murata N, Sudo M, Fukamachi D, Okumura Y. Association Between Aortic Wall Parameters on Multidetector Computed Tomography and Ruptured Plaques By Nonobstructive General Angioscopy. J Am Heart Assoc 2024; 13:e033233. [PMID: 38497463 PMCID: PMC11010013 DOI: 10.1161/jaha.123.033233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 02/20/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Nonobstructive general angioscopy (NOGA) can identify vulnerable plaques in the aortic lumen that serve as potential risk factors for cardiovascular events such as embolism. However, the association between computed tomography (CT) images and vulnerable plaques detected on NOGA remains unknown. METHODS AND RESULTS We investigated 101 patients (67±11 years; women, 13.8%) who underwent NOGA and contrast-enhanced CT before or after 90 days in our hospital. On CT images, the aortic wall thickness, aortic wall area (AWA), and AWA in the vascular area were measured at the thickest point from the 6th to the 12th thoracic vertebral levels. Furthermore, the association between these measurements and the presence or absence of NOGA-derived aortic plaque ruptures (PRs) at the same vertebral level was assessed. NOGA detected aortic PRs in the aortic lumens at 145 (22.1%) of the 656 vertebral levels. The presence of PRs was significantly associated with greater aortic wall thickness (3.3±1.7 mm versus 2.1±1.2 mm), AWA (1.33±0.68 cm2 versus 0.89±0.49 cm2), and AWA in the vascular area (23.2%±9.3% versus 17.2%±7.6%) (P<0.001 for all) on the CT scans compared with the absence of PRs. The frequency of PRs significantly increased as the aortic wall thickness increased. Notably, a few NOGA-derived PRs were detected on CT in near-normal intima. CONCLUSIONS The presence of NOGA-derived PRs was strongly associated with increased aortic wall thickness, AWA, and AWA in the vascular area, measured using CT. NOGA can detect PRs in the intima that appear almost normal on CT scans.
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Affiliation(s)
- Masatsugu Miyagawa
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Keisuke Kojima
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Kurara Takahashi
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Yuki Nakajima
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Shohei Migita
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Saki Mizobuchi
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Yudai Tanaka
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Katsunori Fukumoto
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Riku Arai
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Tomoyuki Morikawa
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Takashi Mineki
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Nobuhiro Murata
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Mitsumasa Sudo
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Daisuke Fukamachi
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Yasuo Okumura
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
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Wakasa S, Hayashi H, Yamazaki T, Izumiya Y, Fukuda D. Thrombus or tumor? Clin Case Rep 2023; 11:e7975. [PMID: 37780915 PMCID: PMC10539678 DOI: 10.1002/ccr3.7975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 07/20/2023] [Accepted: 09/15/2023] [Indexed: 10/03/2023] Open
Abstract
Key clinical message Contrast defects in veins are often diagnosed as benign thrombi, but depending on the patient's background it is necessary to differentiate between tumor thrombi. It is difficult to differentiate between these using contrast-enhanced CT alone, but with angioscopy it is easy to visually distinguish between a benign and tumor thrombi. Abstract Contrast-enhanced computer tomography (CT) performed on a male patient being treated for de-differentiated chondrosarcoma revealed contrast defects in the pulmonary artery and right femoral vein, and a diagnosis of pulmonary artery thromboembolism and venous thromboembolism was made, and oral anticoagulant therapy was started. However, a follow-up CT showed that the contrast defect had extended to the inferior vena cava. Observation using an angioscope revealed that it was not a benign thrombi but a tumor.
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Affiliation(s)
- Shiho Wakasa
- Department of Cardiovascular MedicineOsaka Metropolitan University Graduate School of MedicineOsakaJapan
| | - Hiroya Hayashi
- Department of Cardiovascular MedicineOsaka Metropolitan University Graduate School of MedicineOsakaJapan
| | - Takanori Yamazaki
- Department of Cardiovascular MedicineOsaka Metropolitan University Graduate School of MedicineOsakaJapan
| | - Yasuhiro Izumiya
- Department of Cardiovascular MedicineOsaka Metropolitan University Graduate School of MedicineOsakaJapan
| | - Daiju Fukuda
- Department of Cardiovascular MedicineOsaka Metropolitan University Graduate School of MedicineOsakaJapan
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Fukutome K, Shiba M, Aketa S, Mitsui T, Shiraishi Y, Hayami H, Murakami Y, Matsuoka R, Tei R, Shin Y, Motoyama Y. Case report: Usefulness of angioscopy in determining antiplatelet drug reduction after carotid artery stenting. Front Neurol 2023; 14:1152173. [PMID: 37731855 PMCID: PMC10507256 DOI: 10.3389/fneur.2023.1152173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 08/14/2023] [Indexed: 09/22/2023] Open
Abstract
We report a case in which neointima was confirmed by angioscopy and antiplatelet drug administration was reduced 2 months after carotid artery stenting (CAS). A patient in their 80s was scheduled to undergo resection for renal cancer; however, he also had right cervical internal carotid artery stenosis. Because this was a risk for general anesthesia, CAS was performed after first starting dual antiplatelet therapy. Urologically, early reduction of antiplatelet drugs was necessary for a nephrectomy. Although no obvious neointima could be identified on ultrasound 2 months after CAS, thin neointima was observed using angioscopy. Based on the above results, we reduced the antiplatelet drug administration, and then the nephrectomy was performed. Ultimately, no cerebral infarction occurred in the perioperative or postoperative periods. Angioscopy allows for visual confirmation of thin neointima. If sufficient neointima can be confirmed, antiplatelet drug reduction can be performed more safely and reliably.
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Affiliation(s)
- Kenji Fukutome
- Department of Neurosurgery, Osaka Police Hospital, Osaka, Japan
| | - Mikio Shiba
- Cardiovascular Division, Osaka Police Hospital, Osaka, Japan
| | - Shuta Aketa
- Department of Neurosurgery, Osaka Police Hospital, Osaka, Japan
| | - Takaaki Mitsui
- Department of Neurosurgery, Osaka Police Hospital, Osaka, Japan
| | - Yuki Shiraishi
- Department of Neurosurgery, Osaka Police Hospital, Osaka, Japan
| | | | | | - Ryuta Matsuoka
- Department of Neurosurgery, Osaka Police Hospital, Osaka, Japan
| | - Rinsei Tei
- Department of Neurosurgery, Osaka Police Hospital, Osaka, Japan
| | - Yasushi Shin
- Department of Neurosurgery, Osaka Police Hospital, Osaka, Japan
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Komatsu S, Takahashi S, Yutani C, Takewa M, Ohara T, Kodama K. Multiple and Multidirectional Fissure Bleedings in a Patient With a Spontaneous Isolated Dissection of the Iliac Artery. Cureus 2023; 15:e38374. [PMID: 37139050 PMCID: PMC10150418 DOI: 10.7759/cureus.38374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2023] [Indexed: 05/05/2023] Open
Abstract
A 63-year-old man with a history of hypertension and dyslipidemia on medication was found to have an enlargement of an asymptomatic iliac artery aneurysm with an ulcer-like projection on computed tomography angiography. The longer and shorter diameter of the right iliac was increased from 24.0 × 18.1 mm to 38.9 × 32.1 mm over four years. Preoperative non-obstructive general angiography revealed multiple, multidirectional fissure bleedings. Fissure bleedings were found where computed tomography angiography appeared normal at the aortic arch. He was diagnosed with spontaneous isolated dissection of the iliac artery and was treated successfully with endovascular treatment.
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Affiliation(s)
- Sei Komatsu
- Cardiovascular Center, Osaka Gyoumeikan Hospital, Osaka, JPN
| | | | - Chikao Yutani
- Cardiovascular Center, Osaka Gyoumeikan Hospital, Osaka, JPN
| | | | - Tomoki Ohara
- Cardiovascular Center, Osaka Gyoumeikan Hospital, Osaka, JPN
| | - Kazuhisa Kodama
- Cardiovascular Center, Osaka Gyoumeikan Hospital, Osaka, JPN
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Sakio T, Egami Y, Nakamura H, Matsunaga-Lee Y, Yano M, Nishino M, Tanouchi J. A Case of Cauterized Tissue Using Laser Photoablation for In-Stent Occlusion of Superficial Femoral Artery. JACC Cardiovasc Interv 2023; 16:347-8. [PMID: 36609042 DOI: 10.1016/j.jcin.2022.10.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/10/2022] [Accepted: 10/18/2022] [Indexed: 01/06/2023]
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Wang Y, Mossa-Basha M, Zhu C. Spontaneously Ruptured Aortic Plaque: A Potential Cause for Frequently Observed Cerebral Infarct? JACC Asia 2022; 2:760-762. [PMID: 36444318 PMCID: PMC9699997 DOI: 10.1016/j.jacasi.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Yuting Wang
- Department of Radiology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Mahmud Mossa-Basha
- Department of Radiology, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Chengcheng Zhu
- Department of Radiology, University of Washington, Seattle, Washington, USA
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Higuchi Y, Hirayama A, Hamanaka Y, Kobayashi T, Sotomi Y, Komatsu S, Yutani C, Kodama K. Significant Contribution of Aortogenic Mechanism in Ischemic Stroke: Observation of Aortic Plaque Rupture by Angioscopy. JACC Asia 2022; 2:750-759. [PMID: 36444317 PMCID: PMC9700032 DOI: 10.1016/j.jacasi.2022.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/05/2022] [Accepted: 07/18/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Although embolic stroke accounts for most cerebral infarction, examinations to identify the embolic source have been insufficient. Nonobstructive general angioscopy (NOGA) has developed to allow the detailed observation of atheromatous changes of the aorta. OBJECTIVES The purpose of this study was to clarify the importance of the aortogenic mechanism in the development of ischemic stroke. METHODS We examined 114 consecutive patients whose aorta was observed by NOGA and who subsequently underwent brain magnetic resonance imaging to detect ischemic stroke lesions. In the evaluation of the aorta, the presence and location of spontaneously ruptured aortic plaque (SRAP) were determined. The aorta was observed from the origin to the arch (proximal aorta [PAo]) and the proximal descending aorta. RESULTS Forty-nine of 114 patients had SRAP observed by NOGA. Among these, 24 had SRAP in the PAo, and 43 had SRAP in the descending aorta. Thirty-three patients had ischemic stroke lesions, including 6 with a clinical neurologic deficit. The frequency at which SRAP was detected in these patients was significantly higher in comparison to 81 patients without ischemic stroke (69% vs 33%; P < 0.01). The sensitivity and specificity of the presence of SRAP for ischemic stroke were 0.70 and 0.68, respectively. The presence of SRAP in PAo was significantly correlated with ischemic stroke (odds ratio: 14.3; P < 0.001). CONCLUSIONS In the treatment of ischemic stroke, attention should be paid to SRAP, especially that in the PAo. (STROKE-NOGA [SponTaneously Ruptured aOrtic plaques as a potential cause of embolic stroKEs visualized by Non-Obstructive General Angioscopy] Study; UMIN000034588).
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Key Words
- AF, atrial fibrillation
- DAo, proximal descending aorta
- DOAC, direct oral anticoagulant
- DWI, diffusion-weighted imaging
- FLAIR, fluid-attenuated inversion recovery
- MRA, magnetic resonance angiography
- MRI, magnetic resonance imaging
- NOGA, nonobstructive general angioscopy
- PAo, proximal aorta
- SRAP, spontaneously ruptured aortic plaque
- TEE, transesophageal echocardiography
- angioscopy
- aortic plaque
- embolic stroke
- ischemic stroke
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Affiliation(s)
| | | | - Yuma Hamanaka
- Cardiovascular Division, Osaka Police Hospital, Osaka, Japan
| | | | - Yohei Sotomi
- Cardiovascular Division, Osaka Police Hospital, Osaka, Japan
| | - Sei Komatsu
- Cardiovascular Center, Osaka Gyoumeikan Hospital, Osaka, Japan
| | - Chikao Yutani
- Morinomiya Academy of Medical Arts and Sciences, Osaka, Japan
| | - Kazuhisa Kodama
- Cardiovascular Center, Osaka Gyoumeikan Hospital, Osaka, Japan
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Tashiro K, Mori H, Tezuka T, Omura A, Wada D, Sone H, Takei Y, Sasai M, Sato T, Suzuki H. Angioscopic Findings of Stenosis Versus Occlusion in Femoropopliteal Artery Disease. J Endovasc Ther 2022; 30:223-231. [PMID: 35179063 DOI: 10.1177/15266028221079759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite the increase in the number of patients with peripheral artery disease (PAD), the pathophysiology is not fully elucidated. Recently, angioscopy with a 0.48-megapixel equivalent resolution camera became available for patients with PAD. We aimed to compare the plaque component between native stenosis and occlusion in the femoropopliteal artery using this modality. MATERIALS AND METHODS Thirty-two consecutive patients who underwent endovascular treatment for native femoropopliteal artery disease with angioscopy were studied. The major angioscopic classifications of each lesion were defined as follows: atheromatous plaque (AP) was defined as luminal narrowing without any protrusion, calcified nodule (CN) was defined as a protruding bump with surface irregularity, a mainly reddish thrombus was defined as organizing thrombus (OG), and organized thrombus (OD) was defined by more than half of the thrombus showing a whitish intima-like appearance. RESULTS A total of 34 lesions (stenosis, n=18; occlusion, n=16) from 32 patients were included. All stenotic lesions showed AP or CN (n=8 [44%], n=10 [56%], respectively), whereas all occluded lesions showed OG or OD (n=5 [31%], n=11 [69%], respectively), which amounted to a statistically significant difference (p<0.001). In occluded lesions, stiff wires (>3 g) were required to cross all lesions classified as OD, whereas this was not always necessary for lesions classified as OG (11 [100%] of 11, 1 [25%] of 5, respectively; p=0.04). Yellow color plaques were observed to a similar degree in all angioscopic classifications. Major adverse limb events, defined as amputation and any reintervention at 12 months, were highly variable, depending on the angioscopic findings, and tended to be more frequently observed in CN and OD (13% in AP, 40% in CN, 0% in OT, and 36% in OD, p=0.25). CONCLUSION Angioscopy revealed varying components in stenosis and occlusion with different degrees of clinical impact. This may provide new information on the pathophysiology of PAD.
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Affiliation(s)
| | | | | | - Ayumu Omura
- Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Daisuke Wada
- Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Hiromoto Sone
- Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Yosuke Takei
- Showa University Fujigaoka Hospital, Yokohama, Japan
| | | | - Tokutada Sato
- Showa University Fujigaoka Hospital, Yokohama, Japan
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Tanabe Y, Suzuki T, Kuwata S, Akashi YJ. Endothelialization of Amplatzer PFO Occluder Device 12 Months After Implantation: First-in-Human Angioscopic Assessment. J Invasive Cardiol 2022; 34:E151. [PMID: 35100559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The current guidelines recommend at least 6 months of antithrombotic and antibiotic prophylaxis following atrial septal occluding device placement using the phrase "until endothelialization." However, neo-endothelialization has not been assessed in vivo in humans. Considering the atrial septal defect occluding device, several autopsy cases and device extraction cases only demonstrated insufficient endothelialization beyond 6 months after implantation caused endocarditis and thrombosis. Accordingly, we have successfully developed a method for determining device endothelialization using angioscopy. This method helped us evaluate the endothelialization of a 25 mm Amplatzer PFO occluder device (Abbott) in a 40-year-old man 12 months after implantation. This is the first report evaluating the PFO occluder device in vivo.
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Affiliation(s)
- Yasuhiro Tanabe
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki-City, Kanagawa 216-8511, Japan.
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Haraguchi T, Kanno D, Fujita T, Hachinohe D, Kaneko U, Kashima Y, Sato K. The First-in-Human High-Resolution Angioscopy of Superficial Femoral Arterial Rupture In-Stent Occlusion Due to Laser Photoablation. JACC Cardiovasc Interv 2021; 14:e321-2. [PMID: 34774472 DOI: 10.1016/j.jcin.2021.08.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 08/31/2021] [Indexed: 11/22/2022]
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Tanabe Y, Suzuki T, Kuwata S, Izumo M, Kawaguchi H, Ogoda S, Kotoku N, Sato Y, Nishikawa H, Kaihara T, Koga M, Mitarai T, Okuyama K, Kamijima R, Ishibashi Y, Yoneyama K, Higuma T, Harada T, Akashi YJ. Angioscopic Evaluation of Atrial Septal Defect Closure Device Neo-Endothelialization. J Am Heart Assoc 2021; 10:e019282. [PMID: 34533044 PMCID: PMC8649546 DOI: 10.1161/jaha.120.019282] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Current guidelines recommend at least 6 months of antithrombotic therapy and antibiotic prophylaxis after septal‐occluding device deployment in transcatheter closure of atrial septal defect. It has been estimated that it takes ≈6 months for complete neo‐endothelialization; however, neo‐endothelialization has not previously been assessed in vivo in humans. Methods and Results The neointimal coverage of septal occluder devices was evaluated 6 months after implantation in 15 patients by angioscopy from the right atrium. Each occluder surface was divided into 9 areas; the levels of endothelialization in each area were semiquantitatively assessed by 4‐point grades. Device neo‐endothelialization was sufficient in two thirds of patients, but insufficient in one third. In the comparison between patients with sufficiently endothelialized devices of average grade score ≥2 (good endothelialization group, n=10) and those with poorly endothelialized devices of average grade score <2 (poor endothelialization group, n=5), those in the poor endothelialization group had larger devices deployed (27.0 mm [25.0–31.5 mm] versus 17.0 mm [15.6–22.5 mm], respectively) and progressive right heart dilatation. The endothelialization was poorer around the central areas. Moreover, the prevalence of thrombus formation on the devices was higher in the poorly endothelialized areas than in the sufficiently endothelialized areas (Grade 0, 94.1%; Grade 1, 63.2%; Grade 2, 0%; Grade 3, 1.6%). Conclusions Neo‐endothelialization on the closure devices varied 6 months after implantation. Notably, poor endothelialization and thrombus attachment were observed around the central areas and on the larger devices.
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Affiliation(s)
- Yasuhiro Tanabe
- Division of Cardiology Department of Internal Medicine St. Marianna University School of Medicine Kanagawa Japan
| | - Tomomi Suzuki
- Division of Cardiology Department of Internal Medicine St. Marianna University School of Medicine Kanagawa Japan
| | - Shingo Kuwata
- Division of Cardiology Department of Internal Medicine St. Marianna University School of Medicine Kanagawa Japan
| | - Masaki Izumo
- Division of Cardiology Department of Internal Medicine St. Marianna University School of Medicine Kanagawa Japan
| | - Hiromasa Kawaguchi
- Department of Clinical Engineering St. Marianna University School of Medicine Kanagawa Japan
| | - Shun Ogoda
- Department of Clinical Engineering St. Marianna University School of Medicine Kanagawa Japan
| | - Nozomi Kotoku
- Division of Cardiology Department of Internal Medicine St. Marianna University School of Medicine Kanagawa Japan
| | - Yukio Sato
- Division of Cardiology Department of Internal Medicine St. Marianna University School of Medicine Kanagawa Japan
| | - Haruka Nishikawa
- Division of Cardiology Department of Internal Medicine St. Marianna University School of Medicine Kanagawa Japan
| | - Toshiki Kaihara
- Division of Cardiology Department of Internal Medicine St. Marianna University School of Medicine Kanagawa Japan
| | - Masashi Koga
- Division of Cardiology Department of Internal Medicine St. Marianna University School of Medicine Kanagawa Japan
| | - Takanobu Mitarai
- Division of Cardiology Department of Internal Medicine St. Marianna University School of Medicine Kanagawa Japan
| | - Kazuaki Okuyama
- Division of Cardiology Department of Internal Medicine St. Marianna University School of Medicine Kanagawa Japan
| | - Ryo Kamijima
- Division of Cardiology Department of Internal Medicine St. Marianna University School of Medicine Kanagawa Japan
| | - Yuki Ishibashi
- Division of Cardiology Department of Internal Medicine St. Marianna University School of Medicine Kanagawa Japan
| | - Kihei Yoneyama
- Division of Cardiology Department of Internal Medicine St. Marianna University School of Medicine Kanagawa Japan
| | - Takumi Higuma
- Division of Cardiology Department of Internal Medicine St. Marianna University School of Medicine Kanagawa Japan
| | - Tomoo Harada
- Division of Cardiology Department of Internal Medicine St. Marianna University School of Medicine Kanagawa Japan
| | - Yoshihiro J Akashi
- Division of Cardiology Department of Internal Medicine St. Marianna University School of Medicine Kanagawa Japan
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Nojima Y, Ihara M, Adachi H, Kurimoto T, Okayama K, Sakata Y, Nanto S. Renal Artery Fibromuscular Dysplasia Observed on Nonobstructive Angioscopy. JACC Cardiovasc Interv 2021; 14:1953-4. [PMID: 34391706 DOI: 10.1016/j.jcin.2021.05.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 05/25/2021] [Indexed: 11/23/2022]
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Teragawa H, Orita Y, Oshita C, Uchimura Y. Intracoronary Thrombogenicity in Patients with Vasospastic Angina: An Observation Using Coronary Angioscopy. Diagnostics (Basel) 2021; 11:1632. [PMID: 34573973 DOI: 10.3390/diagnostics11091632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/26/2021] [Accepted: 09/03/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Despite significant interest in intracoronary thrombi in patients with vasospastic angina (VSA), the phenomenon remains unclarified. Therefore, we investigated a possible relationship using coronary angioscopy (CAS) in VSA patients. METHODS Sixty patients with VSA, for whom we could assess the spastic segment using CAS, were retrospectively studied. An intracoronary thrombus on CAS was a white thrombus and an erosion-like red thrombus. We verified the clinical characteristics and lesional characteristics as they determined the risk of intracoronary thrombus formation. RESULTS There were 18 (30%) patients with intracoronary thrombi. More of the patients with intracoronary thrombi were male, current smokers and had severe concomitant symptoms; however, no statistically significant difference was observed upon logistic regression analysis. There were 18 (26%) coronary arteries with intracoronary thrombi out of 70 coronary arteries recognised in the spastic segments. Furthermore, atherosclerotic changes and segmental spasms were significant factors responsible for such lesions. CONCLUSION Intracoronary thrombi occurred in 30% of VSA patients and much attention should be paid to the intracoronary thrombogenicity of VSA patients.
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15
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Knappich C, Lang T, Tsantilas P, Schmid S, Kallmayer M, Haller B, Eckstein HH. Intraoperative completion studies in carotid endarterectomy: systematic review and meta-analysis of techniques and outcomes. Ann Transl Med 2021; 9:1201. [PMID: 34430642 PMCID: PMC8350645 DOI: 10.21037/atm-20-2931] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 10/16/2020] [Indexed: 11/18/2022]
Abstract
Background Declining perioperative stroke and death rates over the past 3 decades have been paralleled by an increasing use of intraoperative completion studies (ICS) following carotid endarterectomy (CEA). Techniques applied include angiography, intraoperative duplex ultrasound (IDUS), flowmetry, and angioscopy. This systematic review and meta-analysis is aiming on providing an overview of techniques and corresponding outcomes. Methods A PubMed based systematic literature review comprising the years 1980 through 2020 was performed using predefined keywords to identify articles on different ICS techniques. Pooled analyses and meta-analyses estimating risk ratios (RR) and 95% confidence intervals (CI) were performed to compare outcomes of different ICS modes to nonapplication of any ICS. I2 values were assessed to quantify study heterogeneities. Results Identification of 34 studies including patients undergoing CEA with angiography (n=53,218), IDUS (n=20,030), flowmetry (n=16,812), and angioscopy (n=2,291). Corresponding rates of perioperative stroke were 1.5%, 1.8%, 3.6%, and 1.5%, perioperative stroke or death occurred in 1.7%, 1.9%, 2.2%, and 2.0%. Intraoperative surgical revision rates were 6.2%, 5.9%, and 7.9% after CEA with angiography, IDUS, and angioscopy, respectively. Compared to nonapplication of any ICS, the pooled analysis revealed angiography to be significantly associated with lower rates of stroke (RR 0.47; 95% CI, 0.36–0.62; P<0.0001) and stroke or death (RR 0.76; 95% CI, 0.70–0.83; P<0.0001). IDUS was significantly associated with lower rates of stroke (RR 0.56; 95% CI, 0.43–0.73; P<0.0001) and stroke or death (RR 0.83; 95% CI, 0.74–0.93; P=0.0018), whereas angioscopy showed a significant association with a lower stroke rate (RR 0.48; 95% CI, 0.033–0.68; P=0.0001), but no effect on the combined stroke or death rate. Angioscopy was associated with a higher intraoperative revision rate compared to angiography (RR 1.29; 95% CI, 1.07–1.54; P=0.006). The meta-analyses confirmed lower perioperative stroke or death rates for angiography (RR 0.83; 95% CI, 0.76–0.91) and IDUS (RR 0.86; 95% CI, 0.76–0.98) compared to non-application of any ICS, whereas flowmetry showed no significant association. Conclusions This study represents the first systematic literature review and meta-analysis on usage of ICSs in CEA. Data strongly indicate a significant beneficial effect of angiography, IDUS, and angioscopy on perioperative CEA outcomes. Any carotid surgeon should consider implementation of ICSs in his routine armamentarium.
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Affiliation(s)
- Christoph Knappich
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Thomas Lang
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Pavlos Tsantilas
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Sofie Schmid
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Michael Kallmayer
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Bernhard Haller
- Institute of Medical Informatics, Statistics and Epidemiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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16
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Tanaka K, Nagai H, Okamura A, Iwamoto M, Watanabe S, Sumiyoshi A, Suzuki S, Tanaka H, Inoue K, Koyama Y, Iwakura K, Fujii K. Calcified Nodules in the Superficial Femoral Artery Confirmed by Intravascular Ultrasound, Angioscopy, and Histology. JACC Case Rep 2020; 2:1862-1866. [PMID: 34317068 PMCID: PMC8299250 DOI: 10.1016/j.jaccas.2020.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/02/2020] [Accepted: 08/11/2020] [Indexed: 06/13/2023]
Abstract
An 84-year-old man was admitted to the authors' hospital for the treatment of intermittent claudication. Angiography revealed an exophytic calcified nodules in the distal superficial femoral artery. Angioscopy also revealed abundant exophytic atherosclerotic calcification. Histology confirmed the diagnosis. (Level of Difficulty: Beginner.).
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Affiliation(s)
| | - Hiroyuki Nagai
- Address for correspondence: Dr. Hiroyuki Nagai, Division of Cardiology, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kita-ku, Osaka 530-0001, Japan.
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17
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Tanabe Y, Mitarai T, Ishibashi Y, Higuma T, Akashi YJ. Endothelialization of a Venous Stent at 1 Month Post Implantation: First-in-Human Angioscopic Assessment. J Invasive Cardiol 2020; 32:E248. [PMID: 32865515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This is the first report to evaluate endothelialization in vivo; the evidence of endothelialization on the venous stent in the early phase suggests that antithrombotic therapy could be stopped in some patients with high risk of bleeding in the chronic phase.
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Affiliation(s)
- Yasuhiro Tanabe
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki-City, Kanagawa 216-8511, Japan.
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18
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Tsuchiya T, Akita S, Oda M, Takamura T, Kitagawa K, Kajinami K, Kitayama M. Possible effect of direct oral anti-coagulant for preventing long stenting lesion from in-stent restenosis in femoropopliteal segment: Case report with angioscopy findings. SAGE Open Med Case Rep 2020; 8:2050313X20945535. [PMID: 32782802 PMCID: PMC7383611 DOI: 10.1177/2050313x20945535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/01/2020] [Indexed: 11/16/2022] Open
Abstract
A 64-year-old female underwent a successful first percutaneous intervention using MISAGO stents for a de novo femoropopliteal lesion. Subsequently, three more effective procedures were done using balloon catheters for in-stent restenosis. In May 2016, a fourth procedure using Zilver PTX stent for in-stent restenosis was carried out. For this final procedure, we added direct oral anti-coagulant as she had additional problem of popliteal vein thrombosis and her femoropopliteal segment remained clear. A Zilver PTX stent, a drug-eluting stent for a peripheral artery, was expected to bring superior outcomes compared to conventional bare nitinol stents (i.e. MISAGO stent). But subsequent studies reported that Zilver PTX stent was not more effective than conventional bare nitinol stents. In our above mentioned case, her angioscopy findings suggest that her successful outcome appears to be related to the added direct oral anti-coagulant.
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Affiliation(s)
- Taketsugu Tsuchiya
- Department of Transcatheter Cardiovascular Therapeutics, Kanazawa Medical University Hospital, Kahoku-gun, Japan
| | - Satori Akita
- Department of Cardiology, Kanazawa Medical University Hospital, Kahoku-gun, Japan
| | - Minako Oda
- Department of Cardiology, Kanazawa Medical University Hospital, Kahoku-gun, Japan
| | - Takaaki Takamura
- Department of Cardiology, Kanazawa Medical University Hospital, Kahoku-gun, Japan
| | - Katsuhide Kitagawa
- Department of Transcatheter Cardiovascular Therapeutics, Kanazawa Medical University Hospital, Kahoku-gun, Japan
| | - Koji Kajinami
- Department of Cardiology, Kanazawa Medical University Hospital, Kahoku-gun, Japan
| | - Michihiko Kitayama
- Department of Transcatheter Cardiovascular Therapeutics, Kanazawa Medical University Hospital, Kahoku-gun, Japan
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19
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Enomoto Y, Egashira Y, Iwama T. What's happening in carotid stent? A case report of prominent plaque protrusion after carotid artery stenting observed on angioscopy. Catheter Cardiovasc Interv 2020; 97:E532-E535. [PMID: 32770728 DOI: 10.1002/ccd.29186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 07/09/2020] [Accepted: 07/19/2020] [Indexed: 11/10/2022]
Abstract
Thromboembolic complications after carotid artery stenting (CAS) remain an unsolved problem, and several intravascular imaging tools have been proposed to clarify the mechanism of these complications. We report a case of intraprocedural plaque protrusion revealed by angioscopy. A 64-year-old woman underwent CAS for left carotid artery stenosis. After stent placement, optical frequency domain imaging demonstrated some plaque protrusion, and angioscopy showed prominent mobile plaque fragments protruding into the vessel between stent struts and confirmed the coverage of the protruded plaque after the overlapping stent was placed. Compared with other tools, angioscopy more clearly revealed plaque protrusion in the vessel after CAS.
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Affiliation(s)
- Yukiko Enomoto
- Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu, Gifu Prefecture, Japan
| | - Yusuke Egashira
- Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu, Gifu Prefecture, Japan
| | - Toru Iwama
- Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu, Gifu Prefecture, Japan
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20
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Spanos K, Nana P, Kouvelos G, Batzalexis K, Matsagkas MM, Giannoukas AD. Completion imaging techniques and their clinical role after carotid endarterectomy: Systematic review of the literature. Vascular 2020; 28:794-807. [PMID: 32493183 DOI: 10.1177/1708538120929793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Completion imaging has been suggested for the intraoperative quality control assessment of the carotid endarterectomy technical success, in order to immediately resolve pathologic findings and accordingly improve patients' outcome. The aim of this study was to present existing evidence of different completion imaging techniques after carotid endarterectomy and their role on clinical outcome. MATERIAL AND METHODS A systematic review was performed searching in MEDLINE, CENTRAL, and Cochrane databases including studies reporting on completion imaging techniques after carotid endarterectomy. RESULTS A total of 12,378 patients in 35 studies (20 retrospective and 15 prospective) underwent a completion imaging technique after carotid endarterectomy: in 19 studies, 5340 patients underwent arteriography; in 5 studies, 2095 angioscopy; in 21 studies, 5722 DUS; and in 2 studies, 150 patients underwent transcranial Doppler. Ten studies assessed > 1 imaging technique. The mean age was 67 ± 7 years old (69% males) with common co-morbidities to be hypertension (74%), smoking (64%), and hyperlipidemia (54%). Almost half of the patients (4949; 44%) were treated for symptomatic disease. In 1104 (9.7%) patients, a major defect was identified intra-operatively, while in 329 patients (2.9%), a minor defect. Common pathological findings were the presence of mural thrombus, carotid dissection, residual stenosis, and intimal flaps. An immediate re-intervention was undertaken in 75% (790/1053) of the patients to treat a major intra-operative imaging finding. In patients with re-intervention, only 2.3% (14/609) had an intra-operative stroke and 0.8% (5/609), a transient ischemic attack, while only 1.4% (8/575) had a stroke and 0.2% a transient ischemic attack (1/575) during 30-day post-operative period. No intra-operative death was reported. In the same period, the restenosis rate of internal and common carotid artery was 0.5% (3/575) and 0.2% (1/575), respectively. CONCLUSION Completion imaging techniques can detect defects in almost 10% of patients that may lead to immediate intra-operative surgical revision with low intra-operative stroke/transient ischemic attack rate and low early carotid restenosis. During the 30-day follow-up period, in those patients, the incidence of stroke/transient ischemic attack may be low but present. This review cannot provide any evidence on which completion imaging technique is better, and the clinical impact conferred by each technique in the absence of a randomized control studies.
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Affiliation(s)
- Konstantinos Spanos
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Petroula Nana
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - George Kouvelos
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Konstantinos Batzalexis
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Miltiadis M Matsagkas
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Athanasios D Giannoukas
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
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21
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Higuchi Y, Hirayama A, Komatsu S, Kodama K. Embolic Stroke Caused by Aortic Ruptured Plaque and Thrombus Visualized by Angioscopy. JACC Case Rep 2020; 2:705-706. [PMID: 34317329 PMCID: PMC8301715 DOI: 10.1016/j.jaccas.2020.02.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 02/20/2020] [Indexed: 06/13/2023]
Abstract
Aortogenic embolization is among the major mechanisms of cryptogenic stroke. Angioscopic surveillance of the aortic wall clearly visualized the existence of thrombi and spontaneously ruptured plaques, which dynamically liberated embolic materials. (Level of Difficulty: Beginner.).
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Affiliation(s)
| | | | - Sei Komatsu
- Cardiovascular Center, Osaka Gyoumeikan Hospital, Osaka, Japan
| | - Kazuhisa Kodama
- Cardiovascular Center, Osaka Gyoumeikan Hospital, Osaka, Japan
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22
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Kobayashi N, Takano M, Miyauchi Y, Shimizu W. An Anomalous Mechanism Causing Failure of Expanded Polytetrafluoroethylene-Covered Nitinol Stents, Evaluated Using Multiple Intravascular Imaging Modalities. JACC Cardiovasc Interv 2020; 13:e73-e75. [PMID: 32222441 DOI: 10.1016/j.jcin.2020.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 02/11/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Nobuaki Kobayashi
- Cardiovascular Center, Nippon Medical School, Chiba Hokusoh Hospital, Chiba, Japan.
| | - Masamichi Takano
- Cardiovascular Center, Nippon Medical School, Chiba Hokusoh Hospital, Chiba, Japan
| | - Yasushi Miyauchi
- Cardiovascular Center, Nippon Medical School, Chiba Hokusoh Hospital, Chiba, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
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23
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Kuwasaki S, Koga S, Akashi R, Ikeda S, Kawano H, Maemura K. Influence of Tyrosine Kinase Inhibitor, Nilotinib, on Delayed Healing of Bare-Metal Stents in Superficial Femoral Arteries: Insights From Angioscopic Findings. JACC Cardiovasc Interv 2019; 12:e85-6. [PMID: 31029618 DOI: 10.1016/j.jcin.2019.02.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 02/19/2019] [Indexed: 11/22/2022]
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24
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Suzuki S, Nakatani S, Sotomi Y, Shiojima I, Sakata Y, Higuchi Y. Serial optical coherence tomography and angioscopic assessments of 10-year in-stent restenosis of Cypher sirolimus-eluting stent treated with drug-coated balloon angioplasty. J Int Med Res 2019; 48:300060519837445. [PMID: 30938569 PMCID: PMC7140181 DOI: 10.1177/0300060519837445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The drug-coated balloon (DCB) angioplasty is considered a standard therapeutic
option for in-stent restenosis. In the present case, we observed high-intensity
spots on optical coherence tomography (OCT) and bright spots on coronary
angioplasty (CAS) immediately after DCB angioplasty. The superficial
high-intensity area on OCT presumably corresponded with the bright spots on CAS.
The high-intensity superficial regions were thought to represent an
iopromide/paclitaxel mixture. The present serial observation demonstrated that
the eluted drugs remained for at least 2 months but disappeared within 6 months.
At the site where we observed the drugs, neointimal growth was successfully
inhibited and stabilized at the 6-month follow-up. The association of eluted
drugs after DCB angioplasty with consequent neointimal growth is of scientific
interest. Further prospective imaging studies with a large sample size are
warranted to clarify this association.
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Affiliation(s)
- Satoshi Suzuki
- Department of Cardiology, Osaka Police Hospital, Osaka, Japan
| | | | - Yohei Sotomi
- Department of Cardiology, Osaka Police Hospital, Osaka, Japan
| | - Ichiro Shiojima
- Department of Medicine II, Kansai Medical University, Hirakata, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
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Seike F, Ikeda S, Kawakami H, Miyoshi T, Oshita A, Inaba S, Okura T, Higaki J, Matsuoka H. Unstable Saphenous Vein Graft Atheroma in Patients With Stable Angina Pectoris. Circ Cardiovasc Interv 2019; 10:CIRCINTERVENTIONS.116.004692. [PMID: 28223301 DOI: 10.1161/circinterventions.116.004692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Fumiyasu Seike
- From the Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Japan (F.S., S.I., T.O., J.H.); Department of Cardiovascular Medicine, Ehime Prefectural Imabari Hospital, Imabari, Japan (F.S., H.K., T.M., A.O., H.M.); and Department of Cardiology, Kitaishikai Hospital, Ozu, Japan (S.I.).
| | - Shuntaro Ikeda
- From the Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Japan (F.S., S.I., T.O., J.H.); Department of Cardiovascular Medicine, Ehime Prefectural Imabari Hospital, Imabari, Japan (F.S., H.K., T.M., A.O., H.M.); and Department of Cardiology, Kitaishikai Hospital, Ozu, Japan (S.I.)
| | - Hideo Kawakami
- From the Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Japan (F.S., S.I., T.O., J.H.); Department of Cardiovascular Medicine, Ehime Prefectural Imabari Hospital, Imabari, Japan (F.S., H.K., T.M., A.O., H.M.); and Department of Cardiology, Kitaishikai Hospital, Ozu, Japan (S.I.)
| | - Toru Miyoshi
- From the Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Japan (F.S., S.I., T.O., J.H.); Department of Cardiovascular Medicine, Ehime Prefectural Imabari Hospital, Imabari, Japan (F.S., H.K., T.M., A.O., H.M.); and Department of Cardiology, Kitaishikai Hospital, Ozu, Japan (S.I.)
| | - Akira Oshita
- From the Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Japan (F.S., S.I., T.O., J.H.); Department of Cardiovascular Medicine, Ehime Prefectural Imabari Hospital, Imabari, Japan (F.S., H.K., T.M., A.O., H.M.); and Department of Cardiology, Kitaishikai Hospital, Ozu, Japan (S.I.)
| | - Shinji Inaba
- From the Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Japan (F.S., S.I., T.O., J.H.); Department of Cardiovascular Medicine, Ehime Prefectural Imabari Hospital, Imabari, Japan (F.S., H.K., T.M., A.O., H.M.); and Department of Cardiology, Kitaishikai Hospital, Ozu, Japan (S.I.)
| | - Takafumi Okura
- From the Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Japan (F.S., S.I., T.O., J.H.); Department of Cardiovascular Medicine, Ehime Prefectural Imabari Hospital, Imabari, Japan (F.S., H.K., T.M., A.O., H.M.); and Department of Cardiology, Kitaishikai Hospital, Ozu, Japan (S.I.)
| | - Jitsuo Higaki
- From the Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Japan (F.S., S.I., T.O., J.H.); Department of Cardiovascular Medicine, Ehime Prefectural Imabari Hospital, Imabari, Japan (F.S., H.K., T.M., A.O., H.M.); and Department of Cardiology, Kitaishikai Hospital, Ozu, Japan (S.I.)
| | - Hiroshi Matsuoka
- From the Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Japan (F.S., S.I., T.O., J.H.); Department of Cardiovascular Medicine, Ehime Prefectural Imabari Hospital, Imabari, Japan (F.S., H.K., T.M., A.O., H.M.); and Department of Cardiology, Kitaishikai Hospital, Ozu, Japan (S.I.)
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26
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Tanabe Y, Sato Y, Izumo M, Ishibashi Y, Higuma T, Harada T, Akashi YJ. Endothelialization of an Amplatzer Septal Occluder Device 6 Months Post Implantation: Is This Enough Time? An In Vivo Angioscopic Assessment. J Invasive Cardiol 2019; 31:E44. [PMID: 30700633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The current guidelines recommend a minimum of 6 months of antithrombotic and antibiotic prophylaxis following septal occluding device placement for transcatheter closure of atrial septal defect. Full neoendothelialization is thought to be completed within 6 months of device implantation; however, there is no method available that can assess the level of neoendothelialization in vivo. This report therefore evaluates endothelialization in vivo and demonstrates that 6 months of postimplantation prophylactic therapy may not provide sufficient time for adequate endothelialization. Further investigations are warranted to determine the optimal duration of these treatments after atrial septal defect closure.
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Affiliation(s)
- Yasuhiro Tanabe
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki-City, Kanagawa 216-8511, Japan.
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27
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Ikeoka K, Okayama K, Watanabe T, Nanto S, Sakata Y, Hoshida S. Refractory Vascular Wall Healing after Paclitaxel-Coated Nitinol Stent Implantation in the Femoropopliteal Artery: A High-Resolution Angioscopic Assessment. Ann Vasc Dis 2018; 11:373-376. [PMID: 30402194 PMCID: PMC6200606 DOI: 10.3400/avd.cr.18-00061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
It is unclear whether arterial healing occurs beyond 1 year following paclitaxel-coated stent implantation in peripheral artery disease. An 81-year-old woman with superficial femoral artery disease underwent endovascular therapy with a paclitaxel-coated stent. An angiography 21 months later revealed peri-stent contrast staining in the superficial femoral artery, and optical frequency domain imaging demonstrated incomplete stent apposition with significant positive vascular remodeling. High-resolution angioscopy detected positive vascular wall remodeling and in-stent yellow plaque more clearly than conventional angioscopy. Refractory superficial femoral arterial wall healing was apparent more than 20 months after paclitaxel-coated stent implantation.
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Affiliation(s)
- Kuniyasu Ikeoka
- Department of Cardiovascular Medicine, Yao Municipal Hospital, Yao, Osaka, Japan
| | - Keita Okayama
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Tetsuya Watanabe
- Department of Cardiovascular Medicine, Yao Municipal Hospital, Yao, Osaka, Japan
| | - Shinsuke Nanto
- Department of Cardiovascular Medicine, Nishinomiya Municipal Central Hospital, Nishinomiya, Hyougo, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Shiro Hoshida
- Department of Cardiovascular Medicine, Yao Municipal Hospital, Yao, Osaka, Japan
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28
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Khan HH, Vijay A, Cooper M, Ghasemian SR. Using Back-Table Angioscopy to Evaluate Renal Allograft Arterial Injury. Prog Transplant 2018; 28:394-395. [PMID: 30223722 DOI: 10.1177/1526924818800049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Hamza Hassan Khan
- 1 Medstar Georgetown Transplant Institute, Georgetown University Hospital, Washington DC, USA
| | - Adarsh Vijay
- 1 Medstar Georgetown Transplant Institute, Georgetown University Hospital, Washington DC, USA
| | - Matthew Cooper
- 1 Medstar Georgetown Transplant Institute, Georgetown University Hospital, Washington DC, USA
| | - Seyed Reza Ghasemian
- 1 Medstar Georgetown Transplant Institute, Georgetown University Hospital, Washington DC, USA
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29
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McVeigh PZ, Moloney T, Wilson BC, Wheatcroft M. High-Resolution Scanning Fiber Angioscopy as an Adjuvant to Fluoroscopy During Endovascular Interventions. J Endovasc Ther 2018; 25:617-623. [PMID: 30122139 DOI: 10.1177/1526602818794663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To demonstrate the feasibility and potential utility of high-resolution angioscopy during common endovascular interventions. METHODS A 3.7-F scanning fiber angioscope was used in 6 Yorkshire pigs to image branch vessel selection, subintimal dissection, wire snaring, and stent placement. The angioscope was introduced in a coaxial fashion within a standard 6-F guide catheter. A clear field of view was provided using continuous heparinized saline flush through the outer guide catheter. The flush flow rate was manually adjusted to provide clear imaging depending on the diameter of the vessel and local blood flow conditions. RESULTS The scanning fiber angioscope was compatible with off-the-shelf catheters and devices commonly used in peripheral and aortic interventions. Video-rate, high-resolution images were obtained during all the interventions tested and provided information that was complementary to simultaneously acquired fluoroscopy. The scanning fiber angioscope was able to detect subintimal dissection and branch vessel stent coverage with higher resolution than fluoroscopy alone. CONCLUSION Endoluminal imaging with the scanning fiber angioscope is feasible with current endovascular devices and provides additional relevant information that cannot be assessed fluoroscopically. The scanning fiber angioscope represents a novel optical platform on which new endovascular techniques may be developed that will minimize radiation and contrast doses for patients.
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Affiliation(s)
- Patrick Z McVeigh
- 1 Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,2 Department of Physics, Ryerson University, Toronto, Ontario, Canada.,3 Division of Vascular Surgery, St Michael's Hospital/University of Toronto, Toronto, Ontario, Canada
| | | | - Brian C Wilson
- 1 Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,5 Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Mark Wheatcroft
- 3 Division of Vascular Surgery, St Michael's Hospital/University of Toronto, Toronto, Ontario, Canada
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30
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Dai K, Suruga K, Nakao Y, Kobayashi Y, Ikegami Y, Takemoto H, Higaki T, Oi K, Kawase T, Nakama Y, Suenari K, Nishioka K, Sakai K, Otsuka M, Shimatani Y, Masaoka Y, Shiode N. Cauliflower-Like Appearance of Calcified Nodules Observed by Coronary Angioscopy. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.117.005722. [PMID: 28916607 DOI: 10.1161/circinterventions.117.005722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kazuoki Dai
- From the Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, Japan.
| | - Kazuki Suruga
- From the Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, Japan
| | - Yasuhisa Nakao
- From the Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, Japan
| | - Yusuke Kobayashi
- From the Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, Japan
| | - Yuki Ikegami
- From the Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, Japan
| | - Hajime Takemoto
- From the Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, Japan
| | - Tadanao Higaki
- From the Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, Japan
| | - Kuniomi Oi
- From the Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, Japan
| | - Tomoharu Kawase
- From the Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, Japan
| | - Yasuharu Nakama
- From the Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, Japan
| | - Kazuyoshi Suenari
- From the Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, Japan
| | - Kenji Nishioka
- From the Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, Japan
| | - Koyu Sakai
- From the Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, Japan
| | - Masaya Otsuka
- From the Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, Japan
| | - Yuji Shimatani
- From the Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, Japan
| | - Yoshiko Masaoka
- From the Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, Japan
| | - Nobuo Shiode
- From the Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, Japan
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31
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Idemoto A, Okamoto N, Tanaka A, Mori N, Nakamura D, Yano M, Makino N, Egami Y, Shutta R, Tanouchi J, Nishino M. Impact of Angioscopic Evaluation for Femoropopliteal In-Stent Restenosis Before and After Excimer Laser Atherectomy. Vasc Endovascular Surg 2017; 51:335-337. [PMID: 28486842 DOI: 10.1177/1538574417707900] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In-stent restenosis (ISR) is a prevalent problem following stenting of femoropopliteal lesions. A potential novel treatment modality for ISR including excimer laser atherectomy (ELA) has become available. We performed ELA for in-stent chronic total occlusion (CTO) of femoropopliteal lesions and evaluated lesion morphology before and after ELA by angioscopy in 2 patients. The angioscopic findings clearly showed removal of in-stent thrombi after ELA. Thus, ELA may be effective for in-stent CTO of femoropopliteal lesions. This is the first report describing the direct visualization of ELA effect for vaporization of thrombi in femoropopliteal in-stent lesions by angioscopy.
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Affiliation(s)
- Akiko Idemoto
- 1 Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | - Naotaka Okamoto
- 1 Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | - Akihiro Tanaka
- 1 Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | - Naoki Mori
- 1 Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | | | - Masamichi Yano
- 1 Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | - Nobuhiko Makino
- 1 Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | - Yasuyuki Egami
- 1 Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | - Ryu Shutta
- 1 Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | - Jun Tanouchi
- 1 Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | - Masami Nishino
- 1 Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
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32
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Brown AJ, Costopoulos C, West NE, Bennett MR. Contemporary invasive imaging modalities that identify and risk-stratify coronary plaques at risk of rupture. Expert Rev Cardiovasc Ther 2014; 13:9-13. [PMID: 25470576 DOI: 10.1586/14779072.2015.989836] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Atherosclerotic plaque rupture is responsible for the majority of myocardial infarctions, with ruptured plaques exhibiting specific morphological features, including large lipid cores, thinner overlying fibrous caps and micro-calcifications. Contemporary imaging modalities are increasingly able to characterize plaques, potentially leading to the identification of precursor lesions that are at high risk of rupture. Observational studies using invasive imaging consistently find that plaques responsible for an acute coronary event display these high-risk morphological features, and recent prospective imaging studies have now established links between baseline plaque characteristics and future cardiovascular events. Despite these promising advances, subsequent overall event rates remain too low for clinical utility. Novel technologies are now required to refine and improve our ability to identify and risk-stratify lesions at risk of rupture, if plaque-based risk evaluation is ever to become reality.
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Affiliation(s)
- Adam J Brown
- Division of Cardiovascular Medicine, University of Cambridge, Level 6, ACCI, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
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33
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Abstract
The incidence of venous extension to the inferior vena cava (IVC) in renal cell carcinoma (RCC) is markedly increased recently mostly due to the advances in diagnostic modalities. Such vascular invasion implies a heightened biologic behavior and a surgical challenge during the course of treatment. In this study, we reviewed the classification guidelines, recent diagnostic tools and up-to-date therapeutic modalities for RCC with IVC tumor thrombi added to the prognostic significance regarding the pathologic nature of vascular invasion; cephalad extent of thrombi and any associated distant metastasis. Also, we are providing our suggestion regarding the use of angioscopy for removal of IVC thrombi in a relatively bloodless field without aggressive surgical manipulations or shunt techniques for maintenance of hemodynamic stability.
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34
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Haigron P, Bellemare ME, Acosta O, Göksu C, Kulik C, Rioual K, Lucas A. Depth-map-based scene analysis for active navigation in virtual angioscopy. IEEE Trans Med Imaging 2004; 23:1380-90. [PMID: 15554126 PMCID: PMC1950238 DOI: 10.1109/tmi.2004.836869] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
This paper presents a new approach dealing with virtual exploratory navigation inside vascular structures. It is based on the notion of active vision in which only visual perception drives the motion of the virtual angioscope. The proposed fly-through approach does not require a premodeling of the volume dataset or an interactive control of the virtual sensor during the fly-through. Active navigation combines the on-line computation of the scene view and its analysis, to automatically define the three-dimensional sensor path. The navigation environment and the camera-like model are first sketched. The basic stages of the active navigation framework are then described: the virtual image computation (based on ray casting), the scene analysis process (using depth map), the navigation strategy, and the virtual path estimation. Experimental results obtained from phantom model and patient computed tomography data are finally reported.
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Affiliation(s)
- P Haigron
- LTSI, INSERM UMR 642, University of Rennes 1, Campus de Beaulieu, 35042 Rennes, France.
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35
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Sanfelippo PM. Intraoperative angioscopically monitored laser-assisted angioplasty in treating lower-extremity atherosclerotic occlusive disease. Tex Heart Inst J 1989; 16:204-6. [PMID: 15227208 PMCID: PMC324883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
As part of an ongoing multi-institutional study, our surgical center offered laser-assisted angioplasty to patients with significant, documented lower-extremity atherosclerotic occlusive disease, as an alternative to standard femoral-popliteal or femoral-tibial bypass. During the 1st 12 months of the study (September 1987 through August 1988), 31 patients had laser-assisted angioplasty in 34 limbs. The procedures were performed with an argon-powered laser probe that features a heated metallic tip and a window that furnishes 20% of the laser energy as a direct argon laser beam. Angioscopic monitoring was provided in each case. The immediate recanalization rate was 82% (28 of 34 limbs). After a follow-up period of 6 to 18 months (mean, 14 months), the patients continue to show clinical improvement of pretreatment symptoms, and noninvasive studies continue to reveal improved segmental arterial pressures. On the basis of this experience, we conclude that angioscopically monitored laser-assisted angioplasty has a role in the management of lower-extremity atherosclerotic occlusive disease.
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Affiliation(s)
- P M Sanfelippo
- Ohio Heart and Thoracic Surgery Center, Columbus, Ohio, USA
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36
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Cortis BS, Harris DM, Principe J. From angiography to angioscopy: informal discussion. Tex Heart Inst J 1986; 13:281-9. [PMID: 15226857 PMCID: PMC351722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Devices for visualizing blood vessels have evolved from a rigid, illuminated tube (1913), to a tube with an added convex lens (1922), to one with a transparent inflatable balloon for displacing blood from the line of vision (1943), to a flexible angioscope (1960s). Recent fiberoptic developments make it possible to visualize the orifices of the coronary arteries and simultaneous laser angioplasty. The characteristic fluorescence of hematoporphyrin derivative under ultraviolet light has been visualized angioscopically in experimental atherosclerotic plaque, where it accumulates and acts as a marker. However, several requirements need to be met in order for angioscopy to fulfill its therapeutic possibilities in angioplasty, thrombolytic therapy, intraoperative inspection of vascular anastomoses, and its diagnostic potential in distinguishing plaques from clots and pulmonary embolisms from other obstructions. These requirements are: (1) variously-sized angioscopes to accommodate iliac, femoral, renal, and coronary arteries; (2) percutaneous introducers in the various sizes to prevent back-bleeding; (3) a more flexible, easily manipulated fiberoptic; (4) a sufficiently inflatable balloon tip; (5) cross hairs and reference points in the optical system; and (6) optimal focal lengths for the areas to be visualized.
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Affiliation(s)
- B S Cortis
- Chicago Medical School and the Department of Otolaryngology--H and S, University of Illinois and Wensky Laser Center, Chicago, Illinois, USA
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