Experimental and Clinical Percutaneous Angioscopy Experience with Dynamic Angioplasty

Abstract

The authors have used ultrathin angioscopes with high optical resolu tion to assess the effects of dynamic angioplasty in vitro and in vivo. Ex perimentally, angioscopy was used to study the effects of the 5F "Kensey" catheter in "normal" porcine coro nary arteries (NPCA) and postmor tem human coronary arteries (PMHCA). In NPCA, the catheter keeps a coaxial position. Intimal flaps (IFs) were seen in 21/23 NPCAs. They occurred with all cam rotation speeds and were usually single and small (less than 25% of lumen). Perfora tions in patent arteries were rare (1/23). However, when the catheter was forced against the wall by passing through a narrowing of 5F diameter (made by a band ligature), perfora tions were more common at higher cam speeds. The epicardium re mained intact in two thirds of perfo rations. Angioscopy visualized perforations in only 10% of cases (1/10),the common sign being that of large and multiple intimal flaps, which were often obstructive (5/10). In PMHCAs, angioscopy was more sensitive than angiography in detect ing atheromatous lesions. The au thors were able to give a better assessment of the effect of dynamic angioplasty on treated lesions, includ ing the demonstration of intimal flaps that were not visible on angiography. In vivo, they have performed percuta neous angioscopy before and after dy namic angioplasty using 8 French Kensey catheters. Angioscopy re vealed features that were not shown angiographically.