The clinical utility of angioscopy during intracoronary stent implantation

Angiographic evidence of thrombus may have important implications during coronary stent deployment procedures. The periprocedural presence of thrombus has been shown to increase the risk of subsequent stent thrombosis. Coronary angioscopy is a new technology that may prove more accurate for the detection of coronary thrombus. Angiographic filling defects suspicious for thrombus were observed in 15 (22%) of 64 patients undergoing coronary angioscopy during stent implantation procedures. Angioscopy confirmed the presence of thrombus in 9 (60%) of these 15 patients. Protruding thrombus was found in four cases and only mural thrombus in five. In six cases (40%) thrombus was not visualized and angioscopy provided an alternative explanation for the angiographic filling defect. Bulky atherosclerotic plaque was seen protruding into the lumen in two cases, disection with protruding fronds of tissue was found in three cases and a ruptured venus valve was found in one final case. Thrombolytic therapy was administered in all four cases containing protruding thrombus, in only two of the five cases containing mural thrombus, and in none of the cases where thrombus was not visualized. Angioscopy was more accurate than angiography for the diagnosis of thrombus and allowed more precise tailoring of the intervention to the underlying anatomical substraight. This resulted in an excellent clinical outcome, with no episodes of stent thrombosis and limitation of the risks associated with thrombolytic therapy to only those patients at increased risk of a thrombotic complication.