Ramee S R, White C J, Collins T J, Mesa J E, Murgo J P
Department of Internal Medicine, Ochsner Medical Institutions, New Orleans, Louisiana 70121.
J Am Coll Cardiol. 1991 Jan;17(1):100-5. doi: 10.1016/0735-1097(91)90710-q.
The feasibility of using a flexible, steerable angioscope to perform coronary angioscopy before and after percutaneous coronary angioplasty was tested. The microangioscope fits through an 8F coronary angioplasty guiding catheter and contains a multifiber viewing bundle incorporated into the body of a 4.3F balloon catheter with a central lumen for distal flushing and guide-wire passage. Angioscopy was performed without complications 45 times in 24 patients, including 6 patients with stable and 18 with unstable angina. Circumferential visualization of the target lesion was successful in 20 (83%) of the 24 patients and improved with operator experience. Excellent visualization of the target lesion was achieved in 16 (94%) of the last 17 patients. Plaque, thrombus and dissection were among the abnormal findings in the 20 patients (4 with stable, 16 with unstable angina) in whom circumferential viewing of the target lesion was achieved. In four patients with restenosis after angioplasty, the lesion morphology was distinctly different from that of lesions in arteries without prior angioplasty. In patients with stable angina, no thrombus or dissection was seen by angiography or angioscopy before angioplasty. In patients with unstable angina, thrombus was detected more frequently by angioscopy than by angiography before angioplasty (8 versus 2 of 16) and after (15 versus 2 of 16) angioplasty. Intimal dissection was also seen much more frequently by angioscopy than by angiography before angioplasty (7 versus 0 of 16) and after angioplasty (16 versus 7 of 16). It is concluded that high resolution percutaneous coronary angioscopy can be performed safely in conjunction with balloon angioplasty. Further investigation is needed before this diagnostic tool can be applied clinically.
对使用可弯曲、可操控血管镜在经皮冠状动脉腔内血管成形术（PTCA）前后进行冠状动脉血管镜检查的可行性进行了测试。这种微型血管镜可通过一根8F冠状动脉血管成形术引导导管，它包含一束多纤维观察束，该观察束整合在一根4.3F球囊导管体内，球囊导管有一个用于远端冲洗和导丝通过的中心腔。在24例患者中进行了45次血管镜检查，均无并发症发生，其中包括6例稳定型心绞痛患者和18例不稳定型心绞痛患者。24例患者中有20例（83%）成功实现了对靶病变的圆周可视化，且随着操作者经验的增加可视化效果有所改善。最后17例患者中有16例（94%）实现了对靶病变的极佳可视化。在实现对靶病变圆周观察的20例患者（4例稳定型心绞痛患者，16例不稳定型心绞痛患者）中，异常发现包括斑块、血栓和夹层。在4例血管成形术后再狭窄的患者中，病变形态与未行血管成形术的动脉病变明显不同。在稳定型心绞痛患者中，血管成形术前血管造影或血管镜检查均未发现血栓或夹层。在不稳定型心绞痛患者中，血管成形术前血管镜检查比血管造影更频繁地检测到血栓（16例中分别为8例和2例），血管成形术后也是如此（16例中分别为15例和2例）。血管成形术前血管镜检查比血管造影更频繁地观察到内膜夹层（16例中分别为7例和0例），血管成形术后也是如此（16例中分别为16例和7例）。结论是，高分辨率经皮冠状动脉血管镜检查可与球囊血管成形术联合安全进行。在这种诊断工具能够临床应用之前，还需要进一步研究。
