We attempted combined use of angioscopy and intravascular
ultrasonography (IVUS) to localize the coronary ostia and
determine the aortic segment to be replaced in patients with
annuloaortic ectasia, because these preoperative informations are
important for selection of an appropriate technique for
reconstructing the coronary artery, to prevent complications, and
also to postoperative follow-up. Two cases with annuloaortic
ectasia underwent angioscopy and IVUS both pre- and
post-operatively. Structure of aortic cusps, position of coronary
ostia, the extent of ectasia with very thin wall were clearly
observed by IVUS. Angioscopy showed milky white luminal surface of
the ectasic segment. After Cabrol’s operation, the sutured portion
of native aorta and graft was clearly identified by IVUS and mural
thrombus and naked surface of graft were observed by angioscopy.
Complications were observed in none. The results indicate
feasibility of combined use of angioscopy and IVUS for
determination of surgical approach and follow-up in patients with
AAE.

Keiichi Tokuhiro

Yasumi Uchida

Kouhei Kawamura

Hiroshi Sakuragawa

Hiroshi Masuhara

Hidefumi Oosawa

Nobuya Koyama

Evaluation of Annuloaortic Ectasia by Angioscopy and IVUS “Report of 2 cases”

Objectives To clarify the underlying mechanism for the high
restenosis rate after the coronary angioplasty for the chronic
total occlusion by using the coronary angioscope.Background
Coronary angioplasty for the chronic total occlusion is associated
with higher restenosis rate than for highly stenotic lesion.
However, the difference in the restenosis rate has not been
discussed from the angioscopic observation.Methods and Results The lesion morphology after coronary
intervention were classified into 4 grade (Grade 0 <mml:math id="E1" xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mo>=</mml:mo></mml:math> no intimal flap; Grade 1 <mml:math id="E2" xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mo>=</mml:mo></mml:math> intimal flap without protrusion; Grade 2 <mml:math id="E3" xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mo>=</mml:mo></mml:math> Intimal flap with protrusion not occlusive; Grade 3
<mml:math id="E4" xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mo>=</mml:mo></mml:math> protruding intimal flaps with occlusion of the vessel
lumen). Coronary angioscopic observation was performed in 46
patients with stable angina. Most of the lesion morphology after
angioplasty in 13 patients with chronic total occlusion was grade
3. On the other hand, none of grade 3 was observed in 36 patients
with severe coronary stenosis.Conclusion The various protrusions into the lumen shown by the angioscope might be a
reason for higher restenosis and reocclusion rates compared with those after the angioplasty
for the severe stenotic lesion.

Takayoshi Adachi

Atsushi Hirayama

Masanori Asakura

Osamu Yamaguchi

Yasunori Ueda

Tsunehiko Kuzuya

Masatsugu Hori

Kazuhisa Kodama

Angioscopic Observation After Coronary Angioplasty for Chronic Coronary Occlusion Comparison With Severe Stenotic Lesion

Endocardial lesions are caused not only by inflammatory processes
but also by myocardial ischemia, resulting in endocardial
thrombosis and cerebral embolism. We deviced a method for direct
visualization of endocardial damages by a novel dye image
cardioscopy with Evans blue and examined its feasibility in
patients with heart disease. The dye was injected into the left
ventricle before and after endomyocardial biopsy. Endocardial
surface was stained in dark blue in 63&#x25; of patients with
angina pectoris before biopsy. After biopsy, the biopsied portions
were stained in blue in all. The results indicate that endocardium
is damaged even in apparently intact LV in patients with ischemic
heart disease and that endomyocardial biopsy causes severe
endocardial damages.

Masahito Kanai

Takeshi Sakurai

Kunio Yoshinaga

Kaneyuki Aoyagi

Takashi Hitsumoto

Masaki Yoshinuma

Takashi Uchi

Hirofumi Noike

Hidefumi Ohsawa

Makiko Takahashi

Tadashi Ebihara

Keiichi Tachihara

Percutaneous Dye Image Cardioscopy for Detection of Endocardial Lesions

Yasumi  Uchida

Preface

The purpose of this study was to evaluate intracoronary thrombi in
the culprit lesions in patients with acute myocardial infarction
&#x28;AMI&#x29; by angioscopy, and to compare them with clinical and
angiographic features. We angioscopically observed the culprit
coronary lesions in 66 patients with AMI &#x28;55 males and 11
females, 63.9<mml:math id="E1" xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mo>&#x00B1;</mml:mo></mml:math>15.4 years old&#x29; just before interventional
therapy. Thrombi were observed in 42 of 66 lesions
&#x28;64&#x25;&#x29;, namely, red thrombi in 16, mixed thrombi in 15,
white thrombi in 11. In patients with complete obstruction
&#x28;TIMI grade 0 and I&#x29;, red thrombi were more frequently
observed than mixed or white thrombi. On the other hand, in
patients with incomplete obstruction &#x28;TIMI grade II and
III&#x29;, white thrombi were more frequently observed than the
others. Angiographically, haziness and filling defect were
significantly more frequently observed in patients with red
thrombi than the others <mml:math id="E2" xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mrow><mml:mrow><mml:mo>(</mml:mo><mml:mrow><mml:mi>p</mml:mi><mml:mo>&#x003C;</mml:mo><mml:mn>0.05</mml:mn></mml:mrow><mml:mo>)</mml:mo></mml:mrow></mml:mrow></mml:math>. The distance from
proximal side branch to thrombi tended to be longer in patients
with red thrombi than the others. The time from onset of AMI
tended to be longer in patients with white thrombi than the
others. These results suggest that blood flow may be an important
determinant of thrombi characterization.

H. Morio

Y. Fujimori

K. Terasawa

O. Hasegawa

A. Matsuo

M. Osegawa

Angioscopic Evaluation of Thrombi in the Culprit Coronary Lesions in Patients With Acute Myocardial Infarction

Background Since long-term administrations of anti-hyperlipidemicagents result in reduction in &#37; stenosis or increase inminimum lumen diameter &#40;MLD&#41; of stenotic coronarysegments, it is generally believed that anti-hyperlipidemic agentsstabilize vulnerable coronary plaques. However, recent pathologicand angioscopic studies revealed that vulnerability of coronaryplaques is not related to severity of stenosis and the rims ratherthan top of the plaques disrupt, and therefore, angiography is notadequate for evaluation of vulnerability.Angioscopy enables macroscopic pathological evaluation of the coronary plaques.Therefore, we carried out a prospective angioscopic open trial for evaluation of thestabilizing effects of bezafibrate on coronary plaques.Methods From April, 1997 to December, 1998, 24 patients underwentcoronary angioscopy of the plaques in the non-targeted vesselsduring coronary interventions and 6 months later. The patientswere divided into control &#40;10 patients, 14 plaques&#41; andbezafibrat &#40;14 patients, 21 plaques&#41; groups. Oraladministration of bezafibrate &#40;Bezatol SR, 400mg/day&#41; wasstarted immediately after the interventions and was continued for6 months. The vulnerability score was determined based onangioscopic characteristics of plaques and it was compared beforeand 6 months later.Results Six months later, vulnerability score was reduced&#40;from 1.6 to 0.8;p &#60; 0.05&#41; in bezafibrate group andunchanged &#40;from 1.4 to 1.3; NS&#41; in control group. Inbezafibrate group, the changes in vulnerability score was notcorrelated with those in &#37; stenosis or MLD.Conclusion The results indicate that bezafibrate can stabilize coronary plaques.

Yoshiharu  Fujimori

Hidefumi  Ohsawa

 Jyunichi  Hirose

Hirofumi  Noike

Keiichi  Tokuhiro

 Masahito  Kanai

Masaki  Yoshinuma

Kazuhito  Mineoka

Takashi  Hitsumoto

Kaneyuki  Aoyagi

Takeshi  Sakurai

Shin  Sato

Kokushi  Yoshinaga

Masaaki  Ozegawa

Hiroshi  Morio

Katsumi  Yamada

Kimiko  Terasawa

Yuuko  Uchida

Tomomitsu  Oshima

Angioscopic Evaluation of Stabilizing Effects of Bezafibrate on Coronary Plaques in Patients With Coronary Artery Disease

To investigate the feasibility of angioscopic-guided percutaneoustransluminal coronary angioplasty and to elucidate the mechanismof efficacy of coronary stenting for acute myocardial infarction,we performed coronary angioscopy in 102 patients with stableangina or acute myocardial infarction. Thrombi and intimal flapswere observed in most patients after coronary angioplasty. Largeintimal splits were seen in one third of patients. Stents wereinserted in 10 patients who were revealed to have a large flap orprotruding split to the inner lumen. Thrombolytic agents wereadministered in 2 patients with large thrombi. Additionaltreatments were required in 32&#37; of patients. No acutemyocardial infarction or unstable angina occurred in patientsduring hospitalization. Thus, angioscopy of the coronary lumenenables clinicians to determine the most appropriate and leastrisky coronary intervention strategy. In patients with acutemyocardial infarction, angioscopy revealed occlusive or protrudingthrombi in 34 of 35 patients. The protruding thrombi disappearedafter stenting. The frequency of large intimal flaps increasedafter predilatation with balloon, but these disappeared afterstenting. The present angioscopic study demonstrates that thecoronary stent compresses the occlusive or protruding thrombi andcovers the ruptured thrombogenic plaque Consequently,smooth-surfaced and wide vessel lumen are obtained.

Kyoichi  Mizuno

Shunnta  Sakai

Shinnya  Yokoyama

Takayoshi  Ohba

Ryuta  Uemura

Yasutsugu  Seimiya

Masamitsu  Takano

Jun  Tanabe

Masato  Tomimura

Takahiro  Imaizumi

Shu Mei Ma

Shigenobu  Inami

Kentarou  Okamatsu

Noritake  Hata

Percutaneous Transluminal Angioscopy During Coronary Intervention

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