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1.
Atherosclerosis ; 352: 96-102, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35300852

RESUMO

BACKGROUND AND AIMS: Development and expansion of cholesterol crystals (CCs) within a lipid rich atherosclerotic core are believed to predispose to plaque rupture. We have used non-obstructive general angioscopy to described a range of appearances of spontaneously ruptured atherosclerotic plaques (SRAPs) in the aorta in-situ, and have confirmed that debris extruding from some SRAPs (puff-chandelier lesions) are rich in cholesterol crystals and leukocytes. The purpose of this study was to characterized the nature of the inflammatory infiltrate of this debris. METHODS: Debris was collected from puff-chandelier lesions at the time of angioscopy in patients with known coronary disease. Prepared specimens were examined by light microscopy, and immunostaining was used to detect markers of activation of the innate inflammatory pathway including CD68, NLRP3, caspase-1, IL-1ß, IL-18, and IL-6. RESULTS: We analysed debris sampled from 20 puff-chandelier lesions. Microscopy confirmed the presence of large CCs, macrophages, fibrin, calcified gruel, lymphocytes, and neutrophils in 100%, 100%, 95%, 25%, 20%, and 15% of the specimens respectively. Immunostaining confirmed the presence of CD68, NLRP3, IL-1ß, and IL-6 within the debris in 100%, 90%, 80%, and 80%, of the specimens respectively. CCs, NLRP3, caspase-1, IL-1ß, IL-18, were also identified in the cytoplasm of macrophages. CONCLUSIONS: Debris from SRAPs with a puff-chandelier appearance invariably contained large CCs associated with a range of activated leukocytes involved in innate inflammation. This observation supports the thesis that the development and enlargement of CCs in the core of lipid rich plaques may precipitate traumatic and inflammatory injury that may lead to plaque rupture.


Assuntos
Placa Aterosclerótica , Angioscopia , Caspases , Colesterol/metabolismo , Humanos , Inflamação/metabolismo , Interleucina-18 , Interleucina-6 , Lipídeos , Proteína 3 que Contém Domínio de Pirina da Família NLR/metabolismo , Placa Aterosclerótica/complicações
2.
J Cardiol ; 80(1): 94-100, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35219551

RESUMO

BACKGROUND: The plaques with higher grade of yellow color by angioscopy are reported to be associated with vulnerability leading to adverse outcomes in coronary artery diseases. However, no studies have been performed for peripheral artery disease (PAD). We aimed to evaluate the relationship of angioscopic findings of peripheral arteries with the long-term prognosis. METHODS: Angioscopy of iliac or femoropopliteal artery was performed before endovascular therapy in patients with PAD. The local plaque color and presence of thrombus were evaluated. Multivariable Cox regression models were used to estimate hazard ratio (HR) for all-cause mortality or major adverse cardiovascular event (MACE) related to the plaque colors as well as presence of thrombus. RESULTS: Among 67 patients, 49.3% had intensive yellow plaques (group H) and the rest had light yellow to yellow ones (group L). Thrombus was detected in 74.6% of the patients and the presence was not different between the two groups. In Kaplan-Meier analysis during a median follow-up of 976 days and 757 days, group H showed increased mortality and MACE compared with group L (p <0.01 for both). Multivariable analysis demonstrated that the intensive yellow color of plaque was independently associated with mortality and MACE [HR: 11.48, 95% confidence interval (CI): 2.19-211.1 and HR: 3.81, 95% CI: 1.36-13.48, respectively] after adjusting for the presence of thrombus. CONCLUSIONS: The yellow color intensity in local plaques by angioscopy may be a novel predictor of long-term prognosis in patients with PAD, regardless of the presence of thrombus.


Assuntos
Doença da Artéria Coronariana , Doença Arterial Periférica , Placa Aterosclerótica , Angioscopia , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/terapia , Vasos Coronários , Humanos , Doença Arterial Periférica/diagnóstico por imagem , Placa Aterosclerótica/diagnóstico por imagem , Prognóstico
3.
J Invasive Cardiol ; 34(2): E151, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-35100559

RESUMO

The current guidelines recommend at least 6 months of antithrombotic and antibiotic prophylaxis following atrial septal occluding device placement using the phrase "until endothelialization." However, neo-endothelialization has not been assessed in vivo in humans. Considering the atrial septal defect occluding device, several autopsy cases and device extraction cases only demonstrated insufficient endothelialization beyond 6 months after implantation caused endocarditis and thrombosis. Accordingly, we have successfully developed a method for determining device endothelialization using angioscopy. This method helped us evaluate the endothelialization of a 25 mm Amplatzer PFO occluder device (Abbott) in a 40-year-old man 12 months after implantation. This is the first report evaluating the PFO occluder device in vivo.


Assuntos
Forame Oval Patente , Dispositivo para Oclusão Septal , Adulto , Angioscopia , Cateterismo Cardíaco/métodos , Humanos , Masculino , Dispositivo para Oclusão Septal/efeitos adversos , Resultado do Tratamento
5.
Cardiovasc Interv Ther ; 37(1): 35-39, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33743168

RESUMO

Coronary angioscopy (CAS) is a unique diagnostic device that allows direct visualization of the vascular luminal surface in living patients. CAS contributes to elucidate the pathology of coronary artery disease. This consensus document provides a standard for CAS examination and assessment.


Assuntos
Angioscopia , Doença da Artéria Coronariana , Consenso , Doença da Artéria Coronariana/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/cirurgia , Humanos , Japão
6.
J Atheroscler Thromb ; 29(3): 362-369, 2022 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33487618

RESUMO

AIM: We aimed to validate the subjective and qualitative angioscopic findings by the objective and quantitative near-infrared spectroscopic (NIRS) assessment to compensate each other's drawbacks. METHODS: This is a single-center prospective observational study. Patients undergoing a planned follow-up coronary angiography after percutaneous coronary intervention were prospectively enrolled from January 2018 to April 2019. The major three vessels were examined by NIRS-intravascular ultrasound, followed by coronary angioscopic evaluation. Yellow color grade on angioscopy was classified into four grades (0, white; 1, slight yellow; 2, yellow; and 3, intensive yellow) at a location of maximal lipid core burden index over 4 mm [LCBI (4)] on NIRS in each vessel. RESULTS: A total of 95 lesions in 44 patients (72.6±6.7 years, 75% male) were analyzed. LCBI (4) was significantly different among different yellow color grades by coronary angioscopy (ANOVA, p<0.001). Positive correlation was found between angioscopic yellow color grade and LCBI (4) (beta coefficient 164.8, 95% confidence interval 122.9-206.7; p<0.001). The best cutoff value of LCBI (4) to predict the presence of yellow plaque (yellow color grade ≥ 2) was 448 (sensitivity 79.3%, specificity 69.7%, C-statistic 0.800, 95% confidence interval 0.713-0.887, p<0.001). CONCLUSION: The qualitative angioscopic assessment was objectively validated by the quantitative NIRS evaluation, which would be helpful for the reinterpretation of the existing evidences of both imaging modalities.


Assuntos
Angioscopia/métodos , Doença da Artéria Coronariana/diagnóstico , Vasos Coronários/diagnóstico por imagem , Lipídeos/análise , Placa Aterosclerótica/diagnóstico , Espectroscopia de Luz Próxima ao Infravermelho/métodos , Idoso , Doença da Artéria Coronariana/metabolismo , Vasos Coronários/metabolismo , Feminino , Seguimentos , Humanos , Masculino , Placa Aterosclerótica/metabolismo , Valor Preditivo dos Testes , Estudos Prospectivos , Ultrassonografia de Intervenção
10.
J Vasc Interv Radiol ; 33(2): 97-103.e1, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34715323

RESUMO

PURPOSE: To determine the correlation between upstream atherosclerosis in the femoropopliteal arteries, assessed using angioscopy, and impaired infrapopliteal runoff. MATERIALS AND METHODS: Thirty-one patients with peripheral arterial disease who underwent endovascular therapy and angioscopy were prospectively included. Yellow plaque color scores were semiquantitatively determined as 0, 1, 2, or 3. Irregular plaques with rough surfaces, similar to gastric ulcers, were defined as ulcerated plaques (UPs). Angioscopic data were correlated with angiographic runoff scores (ARS). RESULTS: UPs were detected in 74.2% of enrolled diseased legs using angioscopy. Mural thrombi were more commonly observed in the femoropopliteal artery in patients with UPs than in those without UPs (91.3% vs 37.5%, respectively; P = .006) and were frequently found on the UPs (21/23 patients with UPs). Univariate and multivariate linear regression analyses revealed that the presence of UPs was positively and independently associated with a poor ARS and that oral anticoagulant use was independently associated with a preferable ARS (standardized ß = 0.462, P = .004 and standardized ß = -0.411, P = .009, respectively, in the multivariate analysis). CONCLUSIONS: UPs, associated with mural thrombi and diagnosed by angioscopic examination, were demonstrated to be one of the factors associated with poor infrapopliteal runoff.


Assuntos
Aterosclerose , Trombose , Angioscopia , Vasos Coronários , Humanos , Fatores de Risco
12.
J Cardiol ; 79(1): 144-152, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34521582

RESUMO

BACKGROUND: Non-obstructive general angioscopy (NOGA) can be used to diagnose aortic atherosclerotic plaques. We examine the association between the number of aortic plaques detected by NOGA and the risk of subsequent cardiovascular events. METHODS: The Evaluation of AtheroScleroTic and rupture events by Non-Obstructive General Angioscopy (EAST-NOGA) was a prospective cohort study of patients with suspected coronary artery disease who underwent NOGA. RESULTS: Of the 577 patients who underwent NOGA, 532 (92%) completed the follow-up (median follow-up: 13 months, interquartile range: 12-16). The median number of plaques per person was 6 (interquartile range: 3-12), and 567 (98%) had at least one aortic plaque. During the 13-month follow-up, 38 (7.1%) patients had a primary composite endpoint [including cardiovascular death, myocardial infarction, stroke, peripheral artery disease (PAD), or worsening renal function], which was significantly associated with chronic kidney disease, a history of PAD, a lower hemoglobin level, and large numbers of aortic plaques [11 (5-17) vs. 6 (2-11), p = 0.003]. A receiver operating characteristic curve analysis for the number of aortic plaques predicting composite endpoints revealed that the cut-off value of aortic plaques was 12. After multivariate adjustment, the presence of ≥12 aortic plaques remained a significant predictor for composite endpoint events (hazard ratio 2.53, 95% confidence interval 1.26-5.04, p = 0.010). CONCLUSIONS: The number of aortic plaques detected by NOGA may predict subsequent clinical events.


Assuntos
Doenças Cardiovasculares , Doença da Artéria Coronariana , Placa Aterosclerótica , Angioscopia , Aorta , Doenças Cardiovasculares/complicações , Doença da Artéria Coronariana/complicações , Humanos , Placa Aterosclerótica/complicações , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Risco
14.
J Am Heart Assoc ; 10(18): e019282, 2021 09 21.
Artigo em Inglês | MEDLINE | ID: mdl-34533044

RESUMO

Background Current guidelines recommend at least 6 months of antithrombotic therapy and antibiotic prophylaxis after septal-occluding device deployment in transcatheter closure of atrial septal defect. It has been estimated that it takes ≈6 months for complete neo-endothelialization; however, neo-endothelialization has not previously been assessed in vivo in humans. Methods and Results The neointimal coverage of septal occluder devices was evaluated 6 months after implantation in 15 patients by angioscopy from the right atrium. Each occluder surface was divided into 9 areas; the levels of endothelialization in each area were semiquantitatively assessed by 4-point grades. Device neo-endothelialization was sufficient in two thirds of patients, but insufficient in one third. In the comparison between patients with sufficiently endothelialized devices of average grade score ≥2 (good endothelialization group, n=10) and those with poorly endothelialized devices of average grade score <2 (poor endothelialization group, n=5), those in the poor endothelialization group had larger devices deployed (27.0 mm [25.0-31.5 mm] versus 17.0 mm [15.6-22.5 mm], respectively) and progressive right heart dilatation. The endothelialization was poorer around the central areas. Moreover, the prevalence of thrombus formation on the devices was higher in the poorly endothelialized areas than in the sufficiently endothelialized areas (Grade 0, 94.1%; Grade 1, 63.2%; Grade 2, 0%; Grade 3, 1.6%). Conclusions Neo-endothelialization on the closure devices varied 6 months after implantation. Notably, poor endothelialization and thrombus attachment were observed around the central areas and on the larger devices.


Assuntos
Angioscopia , Comunicação Interatrial , Comunicação Interatrial/diagnóstico por imagem , Comunicação Interatrial/cirurgia , Humanos
19.
Int J Cardiovasc Imaging ; 37(10): 2849-2859, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33993421

RESUMO

PURPOSE: Histopathological or intracoronary image assessment of healed plaques (HPs) has been reported. However, the lesion characteristics of HPs remains undetermined yet. We assessed the healed plaque components in patients with coronary artery lesions using multiple imaging modalities. METHODS: We enrolled 33 stable angina pectoris (SAP) patients with 36 native coronary culprit lesions with angiography severe stenosis and without severe calcification undergoing pre-intervention optical coherence tomography (OCT) and coronary angioscopy (CAS). HPs were defined as layered phenotype on OCT. Lesion morphologies and plaque characteristics of HPs were assessed using OCT and CAS. RESULTS: HPs were observed in 19 lesions (52.8%). HP lesions had higher frequent B2/C lesions (89.4% vs. 52.9%, p = 0.02), worse pre-PCI coronary flow (corrected thrombolysis in myocardial infarction count 21.6 ± 13.5 vs. 13.8 ± 6.2, p = 0.047) and greater lumen-area stenosis (79.6 ± 10.6% vs. 68.0 ± 21.6%, p = 0.047) than non-HP lesions. HP lesions had higher prevalence of OCT-thin-cap fibroatheroma (TCFA) (31.6% vs. 0.0%, p = 0.02), OCT-macrophage (89.5% vs. 41.2%, p = 0.004), and CAS-red thrombus (89.5% vs. 41.2%, p = 0.004) than non-HP lesions. The combination of 3 features including OCT-TCFA, macrophages, and CAS-red thrombus showed higher predictive valuer for HPs on OCT than each single variable. Post-PCI irregular tissue protrusion was more frequently observed in lesions with HPs than in those without (52.6% vs. 13.3%, p = 0.03). CONCLUSIONS: SAP lesions with HPs might have more frequent vulnerable plaques with intraplaque inflammation and thrombus than those without, suggesting that layered phenotype on OCT might reflect not only healing process but also potential risks for future coronary events.


Assuntos
Doença da Artéria Coronariana , Infarto do Miocárdio , Intervenção Coronária Percutânea , Placa Aterosclerótica , Angioscopia , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Humanos , Intervenção Coronária Percutânea/efeitos adversos , Valor Preditivo dos Testes , Tomografia de Coerência Óptica
20.
J Atheroscler Thromb ; 28(7): 786-788, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-33814487

RESUMO

We have a great interest in the article in Journal of Atherosclerosis and Thrombosis by Suzuki et al. titled Complex Aortic Arch Atherosclerosis in Acute Ischemic Stroke Patients with Non-Valvular Atrial Fibrillation. The authors demonstrated that 38.7% transesophageal echocardiography-derived complex aortic arch plaques (CAPs) among 106 patients with acute ischemic strokes with atrial fibrillation (AF), suggesting that patients with acute ischemic stroke and AF often had CAPs. The atheromatous lesions at the aortic arch are one of the causes of ischemic strokes. The cause of acute ischemic strokes in patients with AF could not only be cardiogenic embolisms due to AF but also aortogenic embolisms due to CAPs. The possibility of concomitant CAPs should be considered for stroke patients with AF. Non-obstructive general angioscopy has the possibility to detect aortic plaques in the aortic arch more accurately than TEE and might help to diagnose atheromatous plaques and embolic materials in the aortic arch. Further studies are needed to elucidate the causes of ischemic strokes and are expected to improve the outcomes for acute ischemic strokes in patients with AF.


Assuntos
Angioscopia/métodos , Doenças da Aorta , Embolia Intracraniana , AVC Isquêmico/diagnóstico por imagem , Placa Aterosclerótica , Idoso de 80 Anos ou mais , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/patologia , Doenças da Aorta/complicações , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/fisiopatologia , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/terapia , Angiografia por Tomografia Computadorizada/métodos , Diagnóstico Diferencial , Imagem de Difusão por Ressonância Magnética/métodos , Humanos , Embolia Intracraniana/epidemiologia , Embolia Intracraniana/etiologia , AVC Isquêmico/etiologia , Masculino , Placa Aterosclerótica/complicações , Placa Aterosclerótica/diagnóstico por imagem , Medição de Risco , Fatores de Risco
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