Author + information
- Received August 12, 1994
- Revision received December 30, 1994
- Accepted March 28, 1995
- Published online July 1, 1995.
- Fernando Alfonso, MD, FESC*,
- Javier Goicolea, MD, FESC,
- Rosana Hernandez, MD, FESC,
- Manuel Goncalves, MD,
- Javier Segovia, MD,
- Camino Bañuelos, MD, FESC,
- Pedro Zarco, MD, FACC and
- Carlos Macaya, MD, FESC
- ↵*Address for correspondence: Dr. Fernando Alfonso, Departamento de Cardiopulmonar, Hospital Universitario “San Carlos”, Ciudad Universitaria. Plaza de Cristo Rey, Madrid 28040, Spain.
Objectives. This study sought to elucidate angioscopic findings in totally occluded vessels before and after intervention.
Background. 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.
Methods. 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 (Thombolysis 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.
Results. 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.
Conclusions. 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.
- Received August 12, 1994.
- Revision received December 30, 1994.
- Accepted March 28, 1995.
- The American College of Cardiology