Matsushita Masato, Takano Masamichi, Munakata Ryo, Sawatani Tomofumi, Kurihara Osamu, Komiyama Hidenori, Murakami Daisuke, Shirakabe Akihiro, Kobayashi Nobuaki, Hata Noritake, Miyauchi Yasushi, Seino Yoshihiko, Shimizu Wataru
Department of Cardiovascular Medicine, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan.
Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan.
AsiaIntervention. 2018 Sep 20;4(2):110-116. doi: 10.4244/AIJ-D-18-00003. eCollection 2018 Sep.
Coronary angioscopy (CAS) is a robust imaging methodology for evaluation of vascular healing response after stenting. However, the procedure requires a guiding catheter with a diameter of more than 6 Fr, which is rather invasive at follow-up angiography. Recently, coronary angioscopes of a smaller diameter have been able to pass through a 4 Fr guiding catheter. This study aimed to investigate the feasibility and safety of slender CAS observation using a 4 Fr guiding catheter.
Thirty-three consecutive patients who underwent follow-up angiography were evaluated. Following usual angiography via the radial artery, the stent segment was observed by non-occlusive CAS through a 4 Fr guiding catheter. Low molecular weight dextran-L (4 mL/sec) was flushed from a guiding catheter to replace coronary blood. The success rate, anatomical or procedural factors related to the success, and incidence of adverse events were examined. The success rate was 84.8% (n=28/33). The luminal diameter at the orifice of the target vessel was larger in the successful than in the failed group (4.03±0.61 mm vs. 3.39±0.61 mm, respectively; p=0.009). The presence of deep engagement of the guiding catheter into the target vessel was a key factor for sufficient observation (100% in the successful group vs. 0% in the failed group; p<0.0001). No adverse events, such as dissection or acute coronary syndrome, were reported.
The new method of CAS through a 4 Fr guiding catheter demonstrated high feasibility and safety. This less invasive observation via CAS may be useful for stent follow-up.
冠状动脉血管镜检查（CAS）是一种用于评估支架置入术后血管愈合反应的可靠成像方法。然而，该操作需要直径大于6F的引导导管，这在随访血管造影时具有较大的侵入性。最近，较小直径的冠状动脉血管镜已能够通过4F引导导管。本研究旨在探讨使用4F引导导管进行纤细CAS观察的可行性和安全性。
对33例连续接受随访血管造影的患者进行评估。经桡动脉进行常规血管造影后，通过4F引导导管进行非闭塞性CAS观察支架节段。从引导导管注入低分子右旋糖酐-L（4 mL/秒）以替代冠状动脉血液。检查成功率、与成功相关的解剖或操作因素以及不良事件的发生率。成功率为84.8%（n = 28/33）。成功组目标血管开口处的管腔直径大于失败组（分别为4.03±0.61 mm和3.39±0.61 mm；p = 0.009）。引导导管深入进入目标血管是充分观察的关键因素（成功组为100%，失败组为0%；p < 0.0001）。未报告诸如夹层或急性冠状动脉综合征等不良事件。
通过4F引导导管进行CAS的新方法显示出高可行性和安全性。这种通过CAS进行的侵入性较小的观察可能对支架随访有用。
