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Angioscopic evaluation of incompletely obstructing coronary intraluminal filling defects: comparison to angiography
B F Uretsky1, B G Denys, P C Counihan
1Cardiac Catheterization and Interventional Laboratories, Presbyterian University Hospital, Pittsburgh, Pennsylvania 15213.
Insights
Coronary angiography shows low sensitivity in detecting intraluminal filling defects like thrombus or intimal flaps. Coronary angioscopy may offer superior or complementary visualization for these coronary artery lesions.
Area of Science:
- Cardiovascular Medicine
- Diagnostic Imaging
Background:
- Coronary angiography is a standard imaging technique for evaluating coronary artery disease.
- Accurate detection and characterization of intraluminal filling defects are crucial for patient management.
Purpose of the Study:
- To evaluate the diagnostic accuracy of coronary angiography in detecting and characterizing intraluminal filling defects.
- To compare coronary angiography with coronary angioscopy, considered the gold standard, for visualizing intraluminal lesions.
Main Methods:
- A study was conducted at 66 sites involving 40 patients.
- Coronary angiography findings were compared with coronary angioscopy results.
- Sensitivity and specificity of angiography for thrombus and intimal flaps were assessed.
Main Results:
- Overall angiographic sensitivity for thrombus was 37% and for intimal flap was 45%.
- Specificity was high (100% for thrombus, 96% for intimal flap).
- Smaller intimal flaps and thrombi were less frequently detected by angiography compared to larger ones.
Conclusions:
- Coronary angiography demonstrates relatively low sensitivity in detecting intraluminal filling defects.
- Coronary angioscopy may be a preferred or adjunctive tool for improved detection of these coronary lesions.
Abstract:
At 66 sites in 40 patients, we evaluated the sensitivity and specificity of coronary angiography in detecting intraluminal filling defects of varying sizes and in characterizing the contents (thrombus, intimal flap, both) of such defects using coronary angioscopy as "the gold standard." Overall angiographic sensitivity for thrombus was 37% and for intimal flap 45%. Specificity for thrombus was 100% and intimal flaps 96%. Angioscopically small flaps were less frequently seen angiographically (28%) than larger sizes (65%, p = 0.03). Angioscopically small thrombi were seen less often angiographically (30%) than larger ones (75%, p = 0.13). Filling defects (intimal flaps, thrombus, both) were characterized correctly in only 37% of sites. Angiography is relatively insensitivity in detecting intraluminal filling defects. Angioscopy may be preferred to or adjunctive with angiography in detecting these lesions.