title: Percutaneous angioscopy of saphenous vein coronary bypass grafts.
abstract: OBJECTIVE
  We compared the results of percutaneous angioscopy and angiography for detecting critical elements of surface lesion morphology in 21 patients undergoing balloon angioplasty of saphenous vein coronary bypass grafts.
  
  
  BACKGROUND
  Angiography remains the standard for diagnosing and treating intravascular pathology associated with atherosclerotic coronary artery disease. It has been demonstrated that coronary angioscopy is more sensitive for identifying more complex atherosclerotic plaques and intracoronary thrombi in native coronary arteries.
  
  
  METHODS
  Angioscopy and angiography were performed before and after angioplasty of "culprit lesions" in bypass grafts. All but one of the patients had unstable angina. The mean age of the saphenous vein coronary bypass grafts was 10.1 +/- 2.4 years (range 5 to 15).
  
  
  RESULTS
  Restenosis at a prior angioplasty site was present in seven patients. Intravascular thrombi were seen by angioscopy in 15 (71%) of 21 versus 4 (19%) of 21 grafts by angiography (p < 0.001). Dissection was identified by angioscopy in 14 (66%) of 21 versus 2 (9.5%) of 21 grafts by angiography (p < 0.01). The presence of friable plaque lining the lumen surface of the vein graft was detected by angioscopy in 11 (52%) of 21 versus 4 (19%) of 21 grafts by angiography (p < 0.05). There was no correlation between age of the bypass graft and the finding of friable plaque.
  
  
  CONCLUSIONS
  We conclude that angioscopy is superior to angiography for detecting complex lesion morphology in bypass grafts and that the presence of friable plaque does not preclude an uncomplicated angioplasty procedure.
authors.affiliation: Department of Internal Medicine, Ochsner Clinic, New Orleans, Louisiana.
authors.forename: C J
authors.initials: CJ
authors.lastname: White
authors.forename: S R
authors.initials: SR
authors.lastname: Ramee
authors.forename: T J
authors.initials: TJ
authors.lastname: Collins
authors.forename: J E
authors.initials: JE
authors.lastname: Mesa
authors.forename: A
authors.initials: A
authors.lastname: Jain
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D017546:Angioscopy / Q000379:methods; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003328:Coronary Thrombosis / Q000175:diagnosis; D005260:Female; D006083:Graft Occlusion, Vascular / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012501:Saphenous Vein / Q000000981:diagnostic imaging / Q000473:pathology / Q000637:transplantation*