Intraoperative coronary angioscopy--technique and results: a study of 38 patients.

Over a period of 11 months, 38 patients submitted to coronary artery revascularization underwent intraoperative angioscopy of the coronary arteries and internal thoracic arteries. Fifty-nine lesions were observed, but only 31 stenoses responsible for coronary insufficiency were observed (33%). Forty-four distal anastomoses were explored (47%) but ten of these explorations were incomplete. None revealed technical failure of the anastomosis. Thirteen harvested left internal mammary arteries were explored. One of the explorations led to rejection of the graft due to an intimal fracture. Some tiny intimal flaps were observed in our experience, as in others. Although the iatrogenic origin of these lesions in relation to the introduction of the angioscope is obvious, it does not seem to influence the outcome of the operation. In our opinion, two main fields appear to be developing in coronary angioscopy: preoperative assessment of the quality of internal thoracic artery grafts, and control of distal graft anastomoses. The flexibility of the angioscopes and of the leading catheters must be improved to minimize the risk of arterial wall traumatic lesions.