ABSTRACT
Coronary atherosclerosis has a high prevalence and is known as the leading cause of death worldwide. Clinically, coronary atherosclerosis is routinely evaluated by coronary angiography, which provides a luminogram of the coronary artery and allows for recognizing lumen narrowing. However, angiography does not allow for the direct assessment of the disease process within the coronary vessel wall. Today, a number of catheter-based imaging methods can overcome this shortcoming and provide physicians with additional information on specific morphological components of atherosclerotic lesions. This article discusses the abilities of intravascular imaging techniques such as intravascular ultrasound (IVUS), IVUS-VH, iMAP, integrated backscatter-IVUS, intravascular optical coherence tomography, near-infrared spectroscopy and angioscopy, to diagnose coronary atherosclerosis and their potential to guide clinical decision making.
Subject(s)
Coronary Artery Disease/diagnosis , Plaque, Atherosclerotic/diagnosis , Angioscopy , Equipment Design , Humans , Spectroscopy, Near-Infrared , Ultrasonography, Interventional/instrumentation , Ultrasonography, Interventional/methodsSubject(s)
Echocardiography , Jugular Veins/diagnostic imaging , Ultrasonography, Doppler, Color , Ultrasonography, Interventional , Venous Thrombosis/diagnostic imaging , Aged, 80 and over , Aortic Valve Stenosis/diagnostic imaging , Aortic Valve Stenosis/surgery , Catheterization, Central Venous , Female , Heart Valve Prosthesis Implantation , Humans , Incidental Findings , Preoperative CareSubject(s)
Aortic Dissection/etiology , Coronary Aneurysm/etiology , Telangiectasia, Hereditary Hemorrhagic/complications , Adult , Aortic Dissection/diagnostic imaging , Coronary Aneurysm/diagnostic imaging , Female , Humans , Telangiectasia, Hereditary Hemorrhagic/diagnostic imaging , Tomography, X-Ray Computed/methodsABSTRACT
In this case report, we present the use of intracardiac echocardiography (ICE) for guiding the cardiac catheterization and subsequent hemodynamic investigation in an unusual patient case with multiple congenital abnormalities (bicuspid aortic valve, left cervical aortic arch, two aortic coarctations) and two aortic valve replacement operations in the past. The ICE catheter (AcuNav) permitted us to accurately and safely puncture the interatrial septum and place the Swan-Ganz catheter in the left ventricle; additionally, visualization of the aortic coarctation in the ascending aorta was also achieved.
Subject(s)
Echocardiography/standards , Heart Defects, Congenital/physiopathology , Heart Valve Prosthesis , Hemodynamics/physiology , Abnormalities, Multiple/diagnostic imaging , Abnormalities, Multiple/physiopathology , Adult , Aorta, Thoracic/abnormalities , Aorta, Thoracic/diagnostic imaging , Aorta, Thoracic/physiopathology , Aortic Coarctation/diagnostic imaging , Aortic Coarctation/physiopathology , Aortic Coarctation/therapy , Aortic Valve/abnormalities , Aortic Valve/diagnostic imaging , Aortic Valve/physiopathology , Cardiac Catheterization , Echocardiography/methods , Female , Heart Defects, Congenital/diagnostic imaging , Heart Defects, Congenital/surgery , Heart Valve Diseases/congenital , Heart Valve Diseases/physiopathology , Heart Valve Diseases/therapy , Heart Valve Prosthesis Implantation , Humans , Mitral Valve/abnormalities , Mitral Valve/diagnostic imaging , Mitral Valve/physiopathologyABSTRACT
AIMS: We sought to compare the effect of intracoronary beta-radiation on the vessel dimensions in de novo lesions using three-dimensional intravascular ultrasound quantification after balloon angioplasty and stenting. METHODS AND RESULTS: Forty patients (44 vessels; 28 balloon angioplasty and 16 stenting) treated with catheter-based beta-radiation and 18 non-irradiated control patients (18 vessels; 10 balloon angioplasty and 8 stenting) were investigated by means of three-dimensional volumetric intravascular ultrasound analysis post-procedure and at 6-8 months follow-up. Total vessel (EEM) volume enlarged after both balloon angioplasty and stenting (+37 mm(3) vs +42 mm(3), P=ns), but vessel wall volume (plaque plus media) also increased similarly (+33 mm(3) vs +49 mm(3), P=ns) in the irradiated patients. Lumen volume remained unchanged in both groups (+3 mm(3) vs -7 mm(3), P=ns). In the stent-covered segments, neointima at follow-up was significantly smaller in the irradiated group than the control group (8 mm(3) vs 27 mm(3), P=0.001, respectively), but the total amount of tissue growth was similar in both groups (33 mm(3) vs 29 mm(3), P=ns). CONCLUSIONS: Intracoronary beta-radiation induces vessel enlargement after balloon angioplasty and/or stenting, accommodating tissue growth. Additional stenting may not play an important role in the prevention of constrictive remodelling in the setting of catheter-based intracoronary beta-radiotherapy.
