The Development and Clinical Feasibility of Percutaneous Transluminal Coronary Angioscopy

• Published in: Journal of Nippon Medical School Vol. 66; no. 1; pp. 7 - 14
• Main Authors: Mizuno, Kyoichi, Sakai, Shunta, Ohkuni, Shinichi, Jing, Zhang, Hayakawa, Hirokazu
• Format: Journal Article
• Language: English
• Published: Japan The Medical Association of Nippon Medical School 1999
• Subjects: Angioplasty, Balloon, Coronary; Angioscopy; Atherectomy; Coronary Disease - pathology; Coronary Disease - therapy; Coronary Vessels - pathology; Feasibility Studies; Fiber Optic Technology; Humans; Stents
• ISSN: 1345-4676; 0048-0444; 1347-3409
• DOI: 10.1272/jnms.66.7

Introduction Coronary angioscopy is a new diagnostic tool that permits non-operative imaging of intravascular structures through the use of a fiber optic system. Coronary angioscopy is playing an ever-expanding role in research and in clinical practice because it provides a precise, full-color, three-dimensional perspective of the interior surface morphology of coronary arteries, whereas ordinary coronary arteriography provides only two-dimensional black and white images. Angioscopy now permits detailed examination of the macromorphology of coronary artery disease that hitherto was unavailable except during autopsy. The ability to discriminate among colors in angioscopy makes it relatively easy to distinguish between a thrombus and a plaque, even if the clot is very small 1-3. Furthermore, angioscopy can also distinguish between types of plaque (e.g., yellow vs white plaque) and types of thrombus (e.g., red vs white thrombus)4,5. The threedimensional perspective and high resolution of angioscopic images can disclose luminal changes in minute plaque ruptures, ulceration, intimal flap or torn tissue strands not typically appreciated by coronary angiography. Therefore, angioscopy is helpful not only in correlating anatomical and pathological features that cannot be detected in routine coronary arteriography, but also in monitoring coronary interventions such as thrombolytic therapy, percutaneous transluminal coronary angioplasty, atherectomy, laser angioplasty or stenting. Table 1 shows differences among different diagnostic tools. This paper will explore the development of coronary angioscopy, technical considerations, clinical results, and areas for future research and development.