Coronary angioscopic evaluation for serial changes of luminal appearance after pharmacological and catheter interventions.
Although preventive pharmacological therapies effectually reduce the risk of cardiovascular events, acute coronary syndrome (ACS) remains a leading cause of morbidity and mortality in our country, Japan. Disruption of atherosclerotic vulnerable plaques and flow-limiting thrombus formation in non-stent segments of native coronary arteries are considered a main mechanism of ACS. In addition, stent thrombosis originating from implanted metallic coronary stents, so-called vulnerable stents, occasionally appears as ACS in the clinical settings. Coronary angioscopy is a unique imaging modality permitting direct visualization of luminal structures, such as atherosclerotic plaque, thrombus, stent struts, and proliferating neointima. On the basis of accumulated angioscopic findings, intense yellow plaques and stents without neointimal coverage are considered vulnerable plaques and vulnerable stents, respectively. In contrast, morphological disappearance of vulnerable plaques or vulnerable stents by pharmacological and trans-catheter therapies imply stabilization of the plaques or stents. Hence, angioscopic assessment for vulnerability (or stability) of atherosclerotic plaques and implanted stents might be useful for risk classification in the future events of ACS. To evaluate serial changes of coronary lumen after pharmacological and catheter interventions using angioscopy might also provide important information on potential benefits and surrogate endpoints of the therapies and on patients' management.
Takano
Masamichi
M
Cardiovascular Center, Chiba-Hokusoh Hospital, Nippon Medical School, Imba, Chiba, Japan. takanom@nms.ac.jp
Mizuno
Kyoichi
K
D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000209:etiology; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation; D017546:Angioscopy; D000818:Animals; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D054855:Drug-Eluting Stents; D006801:Humans; D008670:Metals; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D018570:Risk Assessment; D015607:Stents; D013927:Thrombosis / Q000175:diagnosis* / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome
D002317:Cardiovascular Agents; D008670:Metals