Visualization of Plaque Erosion With Laser Angioscopy
Sarosh Irfan Madhani1, Jorge Arturo Larco2, Reade Quinton3
1Department of Neurological Surgery, Corewell Health/Michigan State University, Grand Rapids, Michigan, USA.
Insights
Plaque erosions, a cause of cardiovascular events, were visualized using laser angioscopy. This technique identified distinct erosions on the arterial surface, offering new insights into cardiovascular pathology.
Area of Science:
- Cardiovascular pathology
- Medical imaging
- Arterial disease
Background:
- Plaque erosions are key pathological features in acute cardiovascular events.
- Current imaging methods have limitations in visualizing these erosions at high resolution.
- Understanding plaque erosion is crucial for managing cardiovascular disease.
Observation:
- A patient with suspected ischemic stroke underwent carotid endarterectomy for internal carotid artery stenosis.
- The resected plaque was analyzed using scanning fiber angioscopy.
- Histology and scanning electron microscopy were used to corroborate angioscopic findings.
Findings:
- Angioscopy revealed flat, mottled red areas on the arterial surface.
- Scanning electron microscopy showed loss of endothelial coverage and erythrocyte entrapment within a fibrin network.
- Histology confirmed the presence of plaque erosions.
Implications:
- Laser angioscopy can effectively identify plaque erosions.
- This imaging modality may improve the diagnosis and understanding of cardiovascular events.
- Further research can explore the clinical utility of angioscopy in managing patients with arterial disease.
Background:
Plaque erosions are distinct pathological entities in patients with acute cardiovascular events. However, high resolution visualization by currently available imaging modalities in patients is limited.
Case Summary:
A 79-year-old man presented to the hospital with left-sided paresis concerning for ischemic stroke. The etiology was suspected to be a symptomatic right internal carotid artery stenosis, for which he underwent carotid endarterectomy. The resected plaque was examined with a scanning fiber angioscope, and findings were corroborated with histology and scanning electron microscopy.
Discussion:
Angioscopy revealed multiple flat areas of mottled red color in the arterial surface, corresponding on scanning electron microscopy to areas of loss of endothelial coverage with numerous erythrocytes entrapped and compressed by an extensive fibrin network. Cross-sectional histology confirmed plaque erosions.
Take-Home Messages:
Plaque erosions are distinct pathological entities of acute cardiovascular events. Laser angioscopy can identify erosions of the vascular surface.
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