Coronary angioscopy of abrupt occlusion after angioplasty.
OBJECTIVE
This study used angioscopy to determine the specific cause of vessel occlusion after percutaneous transluminal coronary angioplasty and compared the angiographic and angioscopic lesion morphologies in this setting.


BACKGROUND
Occlusion of a dilated coronary artery is the major cause of morbidity and mortality after coronary angioplasty. Attempts to reopen occluded vessels are either empirically guided or directed by angiography, which has inherent limitations. Angioscopy, the in vivo direct visualization of the endovascular surface, is potentially a more accurate means of identifying the cause of vessel occlusion after angioplasty.


METHODS
Percutaneous coronary angioscopy was performed in 17 patients (17 vessels) after angiographic confirmation of postangioplasty vessel occlusion.


RESULTS
Angioscopy demonstrated the primary cause of the postangioplasty occlusion to be dissection in 14 patients (82%) and intracoronary thrombi in 3 (18%). Compared with angioscopy, angiography was significantly less accurate in identifying the specific cause of the occlusion and correctly identified the cause of vessel occlusion in only 5 (29%) of 17 patients (p < 0.001), including 4 (29%) of 14 deep dissections and 1 (33%) of 3 occlusive thrombi.


CONCLUSIONS
Angioscopy specifically identified the cause of occlusion in every patient, with coronary dissection the predominant cause of abrupt occlusion after coronary angioplasty. However, angiography was unable to identify a specific cause for vessel occlusion in the majority of our patients. Angioscopy may therefore prove useful in selecting specific treatment strategies for patients with abrupt occlusion after angioplasty, such as stent placement, atherectomy, repeat dilation or thrombolysis.
White
C J
CJ
Department of Invasive Cardiology, HCI International Medical Center, Clydebank, Scotland, United Kingdom.
Ramee
S R
SR
Collins
T J
TJ
Jain
S P
SP
Escobar
A
A
D000784:Aortic Dissection / Q000150:complications / Q000175:diagnosis; D015906:Angioplasty, Balloon, Coronary; D017546:Angioscopy; D003323:Coronary Aneurysm / Q000150:complications / Q000175:diagnosis; D017023:Coronary Angiography; D003327:Coronary Disease / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D003328:Coronary Thrombosis / Q000150:complications / Q000175:diagnosis; D003331:Coronary Vessels / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence