Isao Shibuya

Angioscopic observation of the coronary luminal changes induced by percutaneous transluminal coronary angioplasty

Coronary luminal changes induced by percutaneous balloon or laser coronary angioplasty were examined angioscopically in 10 patients with ischemic heart disease. A fiberscope (2.6F to 5.3F) was introduced into the coronary artery with the use of a guiding catheter with or without a balloon at the tip. Angioscopy was successful before angioplasty in nine and after angioplasty in 10 of 11 coronary segments. Before angioplasty, the stenotic segments were composed of yellowish or whitish atheromatous plaques with smooth surfaces or spiral folds in patients with stable angina pectoris. In one patient with unstable angina pectoris, the stenotic segment was scalloped angiographically and showed an irregular and whitish plaque angioscopically. After angioplasty, endothelial exfoliation with scattered thrombi (10 segments), bellows-like folds (two), longitudinal cleft (one), plaque rupture (two), and intimal dissection (two) could be identified angioscopically. These changes, with the exception of dissection, could not be identified angiographically. In one patient who underwent thermal argon laser angioplasty, the dilated segment appeared brownish, which indicated carbonization. In one patient with acute myocardial infarction, the occlusive thrombi were vaporized by thermal laser angioplasty. The results demonstrate the clinical feasibility of percutaneous angioscopy for pathologic documentation of coronary luminal changes before and after angioplasty.