Höher M, Hombach V, Höpp H W, Hannekum A, Hügel W, Hilger H H
Department of Cardiology, University of Ulm, FRG.
Int J Card Imaging. 1988;3(2-3):153-9. doi: 10.1007/BF01814888.
Coronary angioscopy (CA) was performed in 30 patients (pts) during cardiac catheterization (Group 1) and in 11 pts during coronary bypass surgery (Group 2) using ultrathin fiberoptic angioscopes (phi 1.2-1.8 mm). For percutaneous CA (Group 1) the angioscope was introduced through a 9F guiding catheter from the femoral artery. The viewing field was cleared by flushing Ringer's solution and short-time occlusion of the coronary ostium by the guiding catheter. In Group 2 CA was performed retrogradely from the distal arteriotomy and through the bypass vein during flushing with cardioplegic solution. In Group 1 in 17/30 pts the coronary artery could be successfully examined by CA. In 13 pts the obstruction was eccentric and irregular shaped. In 2/5 pts, in whom CA was performed successfully pre and post balloon dilatation, CA after PTCA revealed an intimal rupture without clinical or angiographical signs of the intimal dissection. In Group 2 in 9/11 pts good visualization of stenoses could be achieved. At the obstruction site CA revealed thrombi in 3 pts and ulcer in 1 pts. In contrast to angiography, which estimates the lumen diameter of a segmental lesion, CA gives information about the luminal shape and the underlying substance of the obstruction (e.g. atheroma, thrombus, ulceration). The main problems in percutaneous CA are the insufficient intraluminal guidance, the insufficient depth of view of the angioscopes, and the limited examination time.
在30例患者（第1组）进行心导管插入术期间以及11例患者（第2组）进行冠状动脉搭桥手术期间，使用超薄纤维光学血管镜（直径1.2 - 1.8毫米）进行了冠状动脉血管镜检查（CA）。对于经皮CA（第1组），血管镜通过股动脉的9F引导导管引入。通过冲洗林格氏溶液并利用引导导管对冠状动脉口进行短时间闭塞来清除视野。在第2组中，在使用心脏停搏液冲洗期间，从远端动脉切开处逆行并通过搭桥静脉进行CA。在第1组中，30例患者中有17例通过CA成功检查了冠状动脉。在13例患者中，阻塞为偏心且形状不规则。在5例成功进行球囊扩张前后CA的患者中，有2例在经皮腔内冠状动脉成形术（PTCA）后CA显示内膜破裂，但无内膜夹层的临床或血管造影迹象。在第2组中，11例患者中有9例狭窄得到了良好的可视化。在阻塞部位，CA显示3例有血栓，1例有溃疡。与估计节段性病变管腔直径的血管造影不同，CA可提供有关管腔形状以及阻塞的潜在物质（如动脉粥样硬化、血栓、溃疡）的信息。经皮CA的主要问题是管腔内引导不足、血管镜视野深度不足以及检查时间有限。
