RESUMO
Cholesterol crystal (CC) embolism is a disease in which CCs from atherosclerotic lesions embolize peripheral arteries, causing organ dysfunction. In this case, a patient with spontaneously ruptured aortic plaques (SRAPs) identified by non-obstructive general angioscopy (NOGA) may have developed a CC embolism. This is the first report of a CC embolism in a patient with SRAPs identified using NOGA, which further supports the previously speculated pathogenesis of CC embolism due to SRAPs.
Assuntos
Angioscopia , Embolia de Colesterol , Placa Aterosclerótica , Humanos , Embolia de Colesterol/complicações , Embolia de Colesterol/diagnóstico , Angioscopia/métodos , Placa Aterosclerótica/complicações , Placa Aterosclerótica/diagnóstico , Placa Aterosclerótica/diagnóstico por imagem , Masculino , Ruptura Aórtica/complicações , Ruptura Aórtica/diagnóstico , Ruptura Espontânea , IdosoRESUMO
BACKGROUND: The relationship between baseline yellow plaque (YP) and vascular response after stent implantation has not been fully investigated. METHODS: This was a sub-analysis of the Collaboration-1 study (multicenter, retrospective, observational study). A total of 88 lesions from 80 patients with chronic coronary syndrome who underwent percutaneous coronary intervention were analyzed. Optical coherence tomography (OCT) and coronary angioscopy (CAS) were serially performed immediately and 11â¯months after stent implantation. YP was defined as the stented segment with yellow or intensive yellow color assessed by CAS. Neoatherosclerosis was defined as a lipid or calcified neointima assessed by OCT. OCT and CAS findings at 11â¯months were compared between lesions with baseline YP (YP group) and lesions without baseline YP (Non-YP group). RESULTS: Baseline YP was detected in 37 lesions (42â¯%). OCT findings at 11â¯months showed that the incidence of neoatherosclerosis was significantly higher in the YP group (11â¯% versus 0â¯%, pâ¯=â¯0.028) and mean neointimal thickness tended to be lower (104⯱â¯43⯵m versus 120⯱â¯48⯵m, pâ¯=â¯0.098). CAS findings at 11â¯months demonstrated that the dominant and minimum neointimal coverage grades were significantly lower (pâ¯=â¯0.049 and Pâ¯=â¯0.026) and maximum yellow color grade was significantly higher (pâ¯<â¯0.001) in the YP group. CONCLUSIONS: Baseline YP affected the incidence of neoatherosclerosis as well as poor neointimal coverage at 11â¯months after stent implantation.
Assuntos
Angioscopia , Vasos Coronários , Intervenção Coronária Percutânea , Placa Aterosclerótica , Stents , Tomografia de Coerência Óptica , Humanos , Masculino , Feminino , Estudos Retrospectivos , Placa Aterosclerótica/diagnóstico por imagem , Pessoa de Meia-Idade , Idoso , Intervenção Coronária Percutânea/efeitos adversos , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/patologia , Neointima/patologia , Neointima/diagnóstico por imagem , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/terapiaAssuntos
Angioscopia , Dissecção Aórtica , Imagem Multimodal , Trombose , Humanos , Masculino , Doença Aguda , Angioscopia/métodos , Aneurisma Aórtico/diagnóstico por imagem , Dissecção Aórtica/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Imagem Multimodal/métodos , Trombose/diagnóstico por imagem , Trombose/etiologia , Tomografia Computadorizada por Raios X , Idoso de 80 Anos ou maisRESUMO
BACKGROUND: Nonobstructive general angioscopy (NOGA) can identify vulnerable plaques in the aortic lumen that serve as potential risk factors for cardiovascular events such as embolism. However, the association between computed tomography (CT) images and vulnerable plaques detected on NOGA remains unknown. METHODS AND RESULTS: We investigated 101 patients (67±11 years; women, 13.8%) who underwent NOGA and contrast-enhanced CT before or after 90 days in our hospital. On CT images, the aortic wall thickness, aortic wall area (AWA), and AWA in the vascular area were measured at the thickest point from the 6th to the 12th thoracic vertebral levels. Furthermore, the association between these measurements and the presence or absence of NOGA-derived aortic plaque ruptures (PRs) at the same vertebral level was assessed. NOGA detected aortic PRs in the aortic lumens at 145 (22.1%) of the 656 vertebral levels. The presence of PRs was significantly associated with greater aortic wall thickness (3.3±1.7 mm versus 2.1±1.2 mm), AWA (1.33±0.68 cm2 versus 0.89±0.49 cm2), and AWA in the vascular area (23.2%±9.3% versus 17.2%±7.6%) (P<0.001 for all) on the CT scans compared with the absence of PRs. The frequency of PRs significantly increased as the aortic wall thickness increased. Notably, a few NOGA-derived PRs were detected on CT in near-normal intima. CONCLUSIONS: The presence of NOGA-derived PRs was strongly associated with increased aortic wall thickness, AWA, and AWA in the vascular area, measured using CT. NOGA can detect PRs in the intima that appear almost normal on CT scans.
Assuntos
Tomografia Computadorizada Multidetectores , Placa Aterosclerótica , Humanos , Feminino , Angioscopia/métodos , Aorta Torácica , AortaAssuntos
Angioscopia , Fibrilação Atrial , Ablação por Cateter , Imagem Multimodal , Ultrassonografia de Intervenção , Humanos , Pessoa de Meia-Idade , Angioscopia/métodos , Fibrilação Atrial/cirurgia , Fibrilação Atrial/diagnóstico por imagem , Ablação por Cateter/efeitos adversos , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/cirurgia , Estenose de Veia Pulmonar/diagnóstico por imagem , Estenose de Veia Pulmonar/etiologiaRESUMO
Atrial fibrillation (AF) is an independent risk factor for stroke and systemic embolism. Cardiogenic and aortogenic emboli are causes of stroke or systemic embolism. Non-obstructive general angioscopy (NOGA) can be used to diagnose aortic intimal findings, including thrombi and atherosclerotic plaques, but little is known about NOGA-derived aortic intimal findings in patients with AF. This study focused on aortic intimal findings in patients with AF and evaluated the association between AF and aortic thrombi detected using NOGA. We enrolled 283 consecutive patients with coronary artery disease who underwent NOGA of the aorta between January 2017 and August 2022. Aortic intimal findings were screened using NOGA after coronary arteriography. The patients were divided into two groups according to their AF history (AF, n = 50 and non-AF, n = 233). Patients in the AF group were older than those in the non-AF group. Sex, body mass index, and coronary risk factors were not significantly different between the two groups. In the NOGA findings, the presence of intense yellow plaques and ruptured plaques was not significantly different between the two groups. Aortic thrombi were more frequent in the AF group than in the non-AF group (92.0 vs. 71.6%, p < 0.001). Multivariate logistic regression found that AF was independently associated with aortic thrombi (odds ratio 3.87 [95% CI 1.28-11.6], p = 0.016). The presence of aortic thrombi observed using NOGA was associated with AF in patients with coronary artery disease. The roles of aortic thrombi as well as cardiogenic embolism may require clarification.
Assuntos
Fibrilação Atrial , Doença da Artéria Coronariana , Embolia , Placa Aterosclerótica , Acidente Vascular Cerebral , Trombose , Humanos , Fibrilação Atrial/complicações , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico , Angioscopia , Aorta , Trombose/complicações , Placa Aterosclerótica/complicações , Placa Aterosclerótica/diagnóstico por imagem , Fatores de Risco , Acidente Vascular Cerebral/complicações , Embolia/complicaçõesRESUMO
BACKGROUND: Imaging modality-based evidence is limited that compares the extent of coronary arterial repair after percutaneous coronary intervention between patients with stable angina pectoris (SAP) and those with acute coronary syndrome (ACS). METHODS: Between December 2018 and November 2021, a single-center, nonrandomized, observational study was conducted in 92 patients with SAP (n = 42) or ACS (n = 50), who were implanted with Orsiro sirolimus-eluting stent (O-SES) providing a hybrid (active and passive) coating and underwent 1-year follow-up by coronary angioscopy (CAS) after implantation. CAS assessed neointimal coverage (NIC), maximum yellow plaque (YP), and mural thrombus (MT). RESULTS: Baseline clinical characteristics were comparable between the SAP and ACS groups. The follow-up periods were comparable between the two groups (390.1 ± 69.9 vs. 390.6 ± 65.7 days, p = 0.99). The incidences of MT at 1 year after implantation were comparable between the two groups (11.4% vs. 11.1%, p = 0.92). The proportions of "Grade 1" in dominant NIC grades were highest in both groups, and the proportions of maximum YP grades and MT were comparable between the two groups. CONCLUSION: O-SES-induced coronary arterial repair at the site of stent implantation, irrespective of the types of coronary artery disease.
Assuntos
Síndrome Coronariana Aguda , Angina Estável , Doença da Artéria Coronariana , Stents Farmacológicos , Intervenção Coronária Percutânea , Trombose , Humanos , Sirolimo , Angina Estável/diagnóstico por imagem , Angina Estável/terapia , Angioscopia , Seguimentos , Síndrome Coronariana Aguda/diagnóstico por imagem , Síndrome Coronariana Aguda/terapia , Angiografia Coronária , Resultado do Tratamento , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/terapia , Intervenção Coronária Percutânea/efeitos adversos , Neointima , PolímerosRESUMO
Little has been reported on the angioscopic and histopathological findings of in-stent restenosis (ISR) in the iliac artery. Here, we report a case of a male patient in his 70s who showed recurrent ISR in the right external iliac artery. We observed the ISR lesions with not only an intravascular ultrasound (IVUS) but also an angioscopy and a biopsy to clarify the mechanism of ISR. These imaging and histopathological findings showed neointimal hyperplasia, and we performed endovascular therapy with covered stent placement to prevent neointimal formation. Not only the IVUS but also the angioscopic and histopathological findings were helpful to clarify the mechanism of ISR and to determine the treatment plan.
Assuntos
Angioscopia , Reestenose Coronária , Humanos , Masculino , Angioscopia/métodos , Angiografia Coronária , Artéria Ilíaca/diagnóstico por imagem , Stents/efeitos adversos , Resultado do Tratamento , Ultrassonografia de Intervenção , IdosoAssuntos
Arteriopatias Oclusivas , Doença Arterial Periférica , Humanos , Angioscopia , Dióxido de Carbono , Artéria Femoral/diagnóstico por imagem , Artéria Poplítea/diagnóstico por imagem , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/cirurgia , Resultado do Tratamento , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/terapiaAssuntos
Angioscopia , Doença da Artéria Coronariana , Humanos , Tomografia de Coerência Óptica/métodos , Stents , Coração , Vasos Coronários/diagnóstico por imagem , Angiografia Coronária , Resultado do Tratamento , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/cirurgiaAssuntos
Angioplastia com Balão , Hipertensão Pulmonar , Embolia Pulmonar , Humanos , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/cirurgia , Angioscopia , Telas Cirúrgicas , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/cirurgia , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/cirurgia , Doença Crônica , Resultado do TratamentoRESUMO
BACKGROUND: Although favorable clinical outcomes have been demonstrated for fluoropolymer-based paclitaxel-eluting stents (FP-DES) in the treatment of femoropopliteal lesions, the vascular response after implantation has not been systematically studied through intravascular imaging.MethodsâandâResults: We angioscopically compared FP-DES: 24 in the early phase (mean [±SD] 3±1 months), 26 in the middle phase (12±3 months), and 20 in the late phase (≥18 months) after implantation. The dominant neointimal coverage grade, heterogeneity of neointimal coverage grade, and thrombus adhesion in the stent segment were evaluated. Neointimal coverage was graded as follows: Grade 0, stent struts exposed; Grade 1, struts bulging into the lumen, although covered; Grade 2, struts embedded in the neointima, but visible; Grade 3, struts fully embedded and invisible. Dominant neointimal coverage and heterogeneity grades were significantly higher in the middle and late phases than in the early phase (all P<0.05), but did not differ significantly between the middle and late phases. The incidence of thrombus adhesion was recorded for all stents in each of the 3 different phases. CONCLUSIONS: The middle and late phases after FP-DES implantation were associated with significantly higher dominant neointimal coverage and heterogeneity grades than the early phase. However, thrombus adhesion was observed in all phases after FP-DES implantation. Arterial healing may not be completed even in the late phase after FP-DES implantation.