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[First clinical experience with coronary endoscopy]
Insights
Coronary endoscopy using ultrathin fibre endoscopes shows promise for visualizing coronary vascular changes and atherosclerosis. While experimental, this technique offers a new dimension in morphological assessment of blood vessels.
Area of Science:
- Cardiovascular Medicine
- Medical Imaging
- Surgical Technology
Background:
- Atherosclerosis and vascular disease require accurate diagnostic methods.
- Current imaging techniques may have limitations in visualizing intricate vessel morphology.
- Minimally invasive endoscopic approaches are being explored for vascular assessment.
Purpose of the Study:
- To evaluate the feasibility and efficacy of ultrathin fibre endoscopes for coronary and peripheral vessel endoscopy.
- To assess the visualization capabilities of this technique in different vascular beds and clinical scenarios.
- To determine the potential of coronary endoscopy in morphological assessment of vascular changes.
Main Methods:
- Utilized two ultrathin fibre endoscopes (1.4 or 1.8 mm diameter, 120 cm working length).
- Performed endoscopy on four groups: cadaver hearts, peripheral vessels in patients, during balloon-catheter dilatation, and intraoperatively.
- Assessed visualization success, vessel pathology (stenosis, atheromatous changes), and procedural safety.
Main Results:
- Successful visualization of normal and diseased vessels in cadaver hearts and peripheral arteries.
- Endoscopy visualized stenosis or occlusion in 2 out of 5 successful coronary endoscopy cases during balloon dilatation.
- Intraoperative visualization of vessels, including distal course and anastomosis sites, was achieved in 7 out of 9 patients.
- No serious adverse events were reported.
Conclusions:
- Coronary and peripheral vessel endoscopy with ultrathin fibre endoscopes is a feasible experimental technique.
- The method provides a new dimension for morphological assessment of coronary vascular changes.
- Further research and development are needed to establish its clinical utility.
Abstract:
In four different groups coronary endoscopy and endoscopy of peripheral vessels was carried out, using two ultrathin fibre endoscopes with a working length of 120 cm and a diameter of 1.4 or 1.8 mm. In a first series of seven cadaver hearts, normal vessels were found in three, one had high-grade stenosis and in the remaining three there were flat whitish atheromatous changes, rather scar-like in appearance. In a second series of 16 patients, the vascular wall in the iliac region was easily visualised in ten, while six showed diffuse atherosclerotic changes of the wall. In a third group of eight patients, coronary endoscopy was carried out at the time of balloon-catheter dilatation; endoscopy was successful in five patients. In two of them, the stenosis or occlusion to be dilated by balloon was visualised. In a fourth series, good visualisation of the vessels was obtained intraoperatively in seven out of nine patients, and in addition the course of the vessel distal to the stenosis as well as the site of anastomosis with the venous bypass graft could be seen. No serious side-effects of the procedure have yet been observed. Coronary endoscopy opens up a new dimension in the morphological assessment of coronary vascular changes. The method must, however, still be regarded as experimental.