Coronary angioscopy during cardiac catheterization and cardiac surgery

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Medical Imaging

Background:

• Coronary angiography provides limited information on the nature of coronary artery obstructions.
• Percutaneous coronary intervention (PCI) outcomes can be influenced by undetected intimal dissections or ruptures.

Purpose of the Study:

• To evaluate the utility of coronary angioscopy (CA) in visualizing coronary artery lesions during cardiac catheterization and coronary bypass surgery.
• To compare the information provided by CA with traditional angiography.

Main Methods:

• Coronary angioscopy (CA) was performed using ultrathin fiberoptic angioscopes (1.2-1.8 mm) in 30 patients during cardiac catheterization (Group 1) and 11 patients during coronary bypass surgery (Group 2).
• In Group 1, CA was performed percutaneously via a 9F guiding catheter, with viewing field cleared by Ringer's solution flush and ostial occlusion.
• In Group 2, CA was performed retrogradely through the bypass vein during cardioplegic solution flush.

Main Results:

• Successful coronary artery examination by CA was achieved in 17/30 patients in Group 1 and 9/11 patients in Group 2.
• CA identified eccentric and irregular obstructions in 13 patients (Group 1).
• In 2/5 patients post-PTCA, CA revealed intimal rupture not evident on angiography; thrombi were seen in 3 and ulceration in 1 patient (Group 2).

Conclusions:

• Coronary angioscopy provides detailed information on luminal shape and obstruction composition (atheroma, thrombus, ulceration), complementing angiography.
• CA can detect intimal ruptures post-PTCA that are not visible angiographically.
• Challenges in percutaneous CA include intraluminal guidance, limited depth of view, and examination time.