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Angioscopic versus angiographic detection of intimal dissection and intracoronary thrombus
P den Heijer1, D P Foley, J Escaned
1Department of Cardiology, Thoraxcenter, University Hospital, Groningen, The Netherlands.
Insights
Coronary angioscopy detects significantly more intracoronary thrombus than angiography, which often misses these critical findings. Angioscopy provides superior detail for intimal dissection and thrombus detection compared to traditional angiography.
Area of Science:
- Cardiology
- Medical Imaging
- Interventional Cardiology
Background:
- Coronary angioscopy offers greater intravascular detail than cineangiography.
- Direct comparison is needed to evaluate angioscopy's diagnostic value.
Purpose of the Study:
- To compare coronary angioscopy and angiography in detecting intimal dissection and intracoronary thrombus.
- To assess the added diagnostic value of angioscopy in coronary imaging.
Main Methods:
- Review of angiograms and angioscopy videotapes from 52 patients by independent observers.
- Standardized definitions for dissection and thrombus applied to both imaging modalities.
- Angioscopic criteria included visible lumen surface changes or mobile structures for dissection, and intraluminal masses for thrombus.
Main Results:
- Angiography and angioscopy agreed on thrombus presence in only 11.5% of cases.
- Angiography missed 48.1% of angioscopically detected thrombi, showing low sensitivity (19%) but high specificity (100%).
- Dissection was detected in 76.9% by angioscopy versus 28.8% by angiography, with no correlation between methods.
Conclusions:
- Coronary angiography significantly underestimates the prevalence of intracoronary thrombus.
- Angioscopy and angiography are complementary for detecting and grading intimal dissections.
- Angioscopy enhances the detection of intracoronary thrombus and intimal dissections.
Objectives:
This study was undertaken to compare coronary angioscopy with angiography for the detection of intimal dissection and intracoronary thrombus.
Background:
It has been demonstrated previously that coronary angioscopy provides more intravascular detail than cineangiography. Both imaging methods have to be compared directly to assess the additional diagnostic value of angioscopy.
Methods:
The angiograms and videotapes of 52 patients who had undergone angioscopy were reviewed independently by two observers unaware of other findings. Classic angiographic definitions were used for dissection and thrombus. Angioscopic dissection was defined as visible cracks or fissures on the lumen surface or mobile protruding structures that are contiguous with the vessel wall. Angioscopic thrombus was defined as a red, white or mixed red and white intraluminal mass.
Results:
Angiography and angioscopy were in agreement in 40.4% of cases in the absence of thrombus and in 11.5% in the presence of thrombus. No fewer than 25 (48.1%) angioscopically observed thrombi remained undetected at angiography. With angioscopy as the standard, although the specificity of angiography for thrombus was 100%, sensitivity was very low at 19%. Angioscopic dissection was present in 40 patients (76.9%) versus angiographic dissection in 15 patients (28.8%). With regard to dissection, there was no correlation between the two imaging methods (r phi = 0.15, p = 0.29).
Conclusions:
Coronary angiography underestimates the presence of intracoronary thrombus. Angioscopy and angiography are complementary techniques for detecting and grading intimal dissections.