Clinical experience of percutaneous coronary angioscopy in cases with coronary artery disease

Direct visualization of the coronary arteries was performed by using a new ultrathin angioscopic catheter system in experimental animals and 4 patients with coronary artery disease during percutaneous transluminal coronary angioplasty (PTCA). In this catheter system, inspection of the coronary arteries was achieved during washout of blood by bolus infusion of 8-10 ml of saline into the coronary artery through the guide catheter. In the preliminary experience with this coronary angioscopic system, there were some limitations. In 2 patients, removal of coronary blood by manual injection of saline was not adequate, and diagnostic TV images could not be obtained. In 2 patients with tortuous coronary arteries, the catheter could not pass to the atheromatous plaques owing to lack of flexibility of the fiberoptic catheter. Furthermore, angina pectoris occurred in 2 patients during angioscopy, owing probably to interference with coronary blood flow by the guide catheter and/or fiberoptic catheter itself. For future clinical application of coronary angioscopy, further improvements in the instrument are necessary.