Alfonso F, Goicolea J, Hernandez R, Goncalves M, Segovia J, Bañuelos C, Zarco P, Macaya C
Cardiopulmonary Department, Hospital Universitario San Carlos, Madrid, Spain.
J Am Coll Cardiol. 1995 Jul;26(1):135-41. doi: 10.1016/0735-1097(95)00186-4.
This study sought to elucidate angioscopic findings in totally occluded vessels before and after intervention.
Coronary angioscopy allows direct visualization of the lumen surface of the coronary arteries; however, the utility of coronary angioscopy during coronary angioplasty of vessels with a total occlusion is unknown.
Twenty-one consecutive patients (mean [+/- SD] 58 +/- 9 years, range 39 to 77; 3 women, 18 men) undergoing dilation of an occluded vessel were studied with coronary angioscopy. Occlusions were classified as functional in 8 patients (Thrombolysis in Myocardial Infarction [TIMI] flow grade 1) and anatomic in 13 (TIMI flow grade 0). Once the guide wire had crossed the occlusion, coronary angioscopy was attempted before and after angioplasty.
In all patients, coronary angioscopy before dilation visualized protruding material occluding the coronary lumen where the guide wire was wedged. The occlusion consisted of red thrombus in 19 patients (90%) (2 with isolated occlusive thrombus, 17 with thrombus associated with atherosclerotic plaque) and protruding yellow plaque in 2 patients (10%). However, on angiography only 7 occlusions (33%) had data consistent with thrombus (p < 0.01 vs. coronary angioscopy). Successful dilation was obtained in 20 patients. After dilation, coronary angioscopy was repeated in 18 patients, revealing residual thrombus with plaque in 16 (89%) and a residual yellow plaque in 2. In addition, coronary angioscopy revealed coronary dissections in 13 patients (72%); however, angiography revealed dissections only in 10 patients (55%) and residual thrombus in 2 (10%) (p < 0.001). In one patient, coronary angioscopy visualized silent distal embolization of a red thrombus not previously recognized on angiography.
Before intervention, coronary angioscopy provides unique insights into the pathologic substrate of occluded coronary vessels. An occlusive plaque with thrombus is the most common underlying substrate in these lesions. After successful dilation, angiographically silent mural thrombus is seen in most patients. This information could be used to assist in the selection of candidates and type of coronary interventions and could also prove to be of prognostic value in patients with occluded vessels.
本研究旨在阐明血管介入前后完全闭塞血管的血管内镜检查结果。
冠状动脉血管内镜可直接观察冠状动脉管腔表面；然而，在冠状动脉血管成形术期间，血管内镜检查在完全闭塞血管中的应用尚不清楚。
对21例连续接受闭塞血管扩张术的患者（平均[±标准差]58±9岁，范围39至77岁；3例女性，18例男性）进行冠状动脉血管内镜检查。闭塞被分类为功能性闭塞8例（心肌梗死溶栓治疗[TIMI]血流分级1级）和解剖性闭塞13例（TIMI血流分级0级）。一旦导丝穿过闭塞部位，在血管成形术前后尝试进行冠状动脉血管内镜检查。
在所有患者中，扩张前的冠状动脉血管内镜检查可见突出物质阻塞导丝楔入部位的冠状动脉管腔。闭塞由19例患者（90%）的红色血栓组成（2例为孤立性闭塞血栓，17例为与动脉粥样硬化斑块相关的血栓），2例患者（10%）为突出的黄色斑块。然而，在血管造影中，只有7例闭塞（33%）的数据与血栓一致（与冠状动脉血管内镜检查相比，p<0.01）。20例患者成功进行了扩张。扩张后，18例患者再次进行冠状动脉血管内镜检查，16例（89%）显示有残留血栓伴斑块，2例显示有残留黄色斑块。此外，冠状动脉血管内镜检查显示13例患者（72%）有冠状动脉夹层；然而，血管造影仅显示10例患者（55%）有夹层，2例（10%）有残留血栓（p<0.001）。在1例患者中，冠状动脉血管内镜检查可见血管造影术前未识别的红色血栓的无症状远端栓塞。
在介入治疗前，冠状动脉血管内镜可为闭塞冠状动脉血管的病理基础提供独特的见解。闭塞性斑块伴血栓是这些病变中最常见的潜在基础。成功扩张后，大多数患者可见血管造影未显示的壁内血栓。这些信息可用于协助选择冠状动脉介入治疗的候选者和类型，也可能对闭塞血管患者具有预后价值。
