Advances in Angioscopic Imaging of Vascular Disease

Yasumi Uchida, Yasuto Uchida

Department of Cardiology, Toho University Medical Center, Tokyo, Japan.
President, Japanese Foundation for Cardiovascular Research, Funabashi, Japan.

DOI: 10.4236/wjcs.2012.24021                

Abstract

Percutaneous angioscopy, using high resolution fiberoptic imaging, allows direct and two-dimensional visualization of the vascular interior, thereby enabling macroscopic pathological diagnosis. Percutaneous angioscopy has revealed that the vascular luminal surface exhibits various colors and morphologies characteristic of different vascular diseases. This imaging technique is used for evaluation of the severity of vascular diseases, staging of atherosclerosis, analysis of thrombus composition, evaluation of interventional and surgical therapies, and for guidance of intravascular interventions such as angioplasty, venous valvuloplasty and aortic stentgrafting. Recently, dye-image angioscopy has been used clinically for analyses of thrombus composition, endothelial damage and plaque composition. Intravascular microscopy was also developed for cellular imaging of vascular disease. Furthermore, fluorescent angioscopy was developed for molecular imaging of substances comprising atherosclerotic plaques. In this article, we describe the history of the development of angioscopy, angioscopic systems and techniques, angioscopic changes associated with vascular diseases, angioscope-guided intravascular therapies, and evaluation of intravascular and surgical therapies. Angioscopic pictures, except those of the coronary arteries, have rarely been published in the literature, so we have included many representative angioscopic pictures obtained by the authors in this article.

Keywords

Angioscope-Guided Intravascular Interventions; Evaluation of Interventional and Surgical Therapies;

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	D. S. Allen and E. A. Graham, “Intracardiac Surgery—A New Method,” The Journal of the American Medical Association, Vol. 79, No. 13, 1922, pp. 1028-1030.
[2]	D. E. Harken and E. M. Glidden, “Experiments in Intracardiac Surgery. II. Intracardiac Visualization,” The Journal of Thoracic and Cardiovascular Surgery, Vol. 12, No. 4, 1943, pp. 566-573.
[3]	H. Sakakibara, T. Ichikawa and J. Hattori, “An Intraoperative Method for Observation of Cardiac Septal Defect Using a Cardio Scope,” Operation, Vol. 10, 1956, pp. 285-290.
[4]	H. Sakakibara, T. Iijima and J. Hattori, “Direct Visual Operation for Aortic Stenosis: Cardioscope Studies,” The Journal of the International College of Surgeons, Vol. 29, No. 5, 1958, pp. 548-552.
[5]	S. Sugie and T. Tanabe, “Observation of the Vascular Movements by Vascular Endoscope,” Naika, Vol. 24, No. 2, 1969, pp. 277-279.
[6]	F. Litvack, W. S. Grundfest, M. E. Lee, R. M. Carrol, R. Fran, A. Chaux, G. Berci, H. B. Rose, J. M. Matroff and J. S. Forrester, “Angioscopic Visualization of Blood Vessel Interior in Animals and Humans,” Clinical Cardiology, Vol. 8, No. 2, 1985, pp. 65-70. doi:10.1002/clc.4960080202
[7]	Y. Uchida, T. Tomru, F. Nakamura, H. Sonoki and T. Sugimoto, “Fiberoptic Angioscopy of Cardiac Chambers, Valves and Great Vessels Using a Guiding Balloon Catheter in Dogs,” American Heart Journal, Vol. 1118, No. 6, 1988, pp. 1297-1302. doi:10.1016/0002-8703(88)90024-5
[8]	M. J. Buckmaster, G. J. Hyde, T. J. Nypaver, E. D. Endean, T. H. Schwarcz and C. S. Kuo, “An Angioscopic Method for Intraluminal Aortic Evaluation and Stent Placement,” Journal of Vascular Surgery, Vol. 21, No. 5, 1995, pp. 818-821. doi:10.1016/S0741-5214(05)80013-8
[9]	J. R. Spears, A. M. Spokojny and H. J. Marais, “Coronary Angioscopy during Cardiac Catheterization,” Journal of the American College of Cardiology, Vol. 6, No. 1, 1985, pp. 93-97. doi:10.1016/S0735-1097(85)80258-8
[10]	Y, Uchida, S. Masuo, T. Tomaru and A. Kato, “Fiberoptic Observation of Coronary Luminal Changes Caused by Transluminal Coronary Angioplasty,” Circulation, Vol. 72, No. 3, 1985, p. 219.
[11]	T. A. Sanborn, J. A. Rygaard, B. M. Westbrook, H. L. Lazar, G. McCormick, A. J. Roberts and I. Madroff, “Intraoperative Angioscopy of Saphenous Vein and Coronary Arteries,” The Thoracic and Cardiovascular Surgeon, Vol. 91, No. 3, 1986, pp. 339-343.
[12]	V. Hombach, M. Hoeher, A. Hannekum, W. Hugel, B. Buran, H. W. Hoeppe and H. Hirche, “Erste Klinische Erfarlungen Mit Koronarendoskopie,” Deutsch Medi Wochenschr, Vol. 111, No. 30, 1986, pp. 1135-1140 doi:10.1055/s-2008-1068597
[13]	C. T. Sherman, F. Litvak, W. Brundfest, M. Lee, A. Hickey, A. Chaux, R. Kass, C. Blanche, J. Matroff, L. Morgenstein, W. Ganz, H. J. C. Swan and J. Forrester, “Coronary Angioscopy in Patients with Unstable Angina Pectoris,” The New England Journal of Medicine, Vol. 315, No. 15, 1986, pp. 909-919.
[14]	Y. Uchida, K. Hasegawa, K. Kawamura and I. Shibuya, “Angioscopic Observation of the Coronary Luminal Changes Induced by Percutaneous Transluminal Angioplasty,” American Heart Journal, Vol. 117, No. 4, 1989, pp. 769-776. doi:10.1016/0002-8703(89)90611-X
[15]	F. Nakamura, J. Kvasnicka, Y. Uchida and H. J. Geshwind, “Percutaneous Angioscopic Evaluation of Luminal Changes Induced by Excimer Laser Angioplasty,” American Heart Journal, Vol. 124, No. 6, 1992, pp. 1467-1472. doi:10.1016/0002-8703(92)90058-4
[16]	Y. Uchida, “Percutaneous Cardiovascular Angioscopy,” In: G. S. Abela, Ed., Lasers in Medicine and Surgery, Kluwer Academic Publishers, Boston, 1990, pp. 399-410.
[17]	V. Hombach, M. Hoeler, M. Koches, T. Eggeling, A. Schmidt, H. W. Hoep and H. H. Hilger, “Pathophysiology of Unstable Angina Pectoris: Correlations with Coronary Angioscopic Images,” European Heart Journal, Vol. 9, 1998, pp. 140-145.
[18]	Y. Uchida, Y. Fujimori, T. Tomaru, O. Oshima and J. Hirose, “Percutaneous Angioplasty of Chronic Obstruction of Peripheral Arteries by a Temperature-Controlled Nd-YAG Laser System,” Journal of Interventional Cardiology, Vol. 5, No. 4, 1992, pp. 301-308. doi:10.1111/j.1540-8183.1992.tb00834.x
[19]	G. Robinski, D. Brisset, F. Phillippe, D. Kremer, C. Layrian, G. Montalescot and D. Thomas, “Effects of Ultrasound Energy on Total Peripheral Artery Occlusions: Initial Angiographic and Angioscopic Results,” Journal of Interventional Cardiology, Vol. 6, No. 2, 1993, pp. 157-163. doi:10.1111/j.1540-8183.1993.tb00848.x
[20]	L. Kollar, G. Kasza, G. Rozsos, G. Menyhei, M. Szabo and L. Horvath, “Internal Carotid Stent Implantation with Angioscopic Control,” Acta Chirurgica Hungarica, Vol. 36, No. 1-4, 1997, pp. 168-169.
[21]	W. Trubel, H. Magometschnigg, Y. al-Hachichi, M. Staudacher, E. Wolner and P. Polterauer, “Intraoperative Control Following Femorodistal Revascularization: Angioscopy Is Superior to Angiography,” The Thoracic and Cardiovascular Surgeon, Vol. 42, No. 4, 1999, pp. 199-207. doi:10.1055/s-2007-1016488
[22]	Y. Uchida, “Aortoscopy,” In: Y. Uchida, Ed., Atlas of Cardioangioscopy, Medical View Publishing, Tokyo, 1995, pp. 180-188.
[23]	B. B. Hill, R. Neville, G. L. Hyde, C. S. Kuo and E. B. Diethrich, “Angioscopic Evaluation of an Endoluminal Aortic Graft: The First Clinical Experience,” Journal of Endovascular Surgery, Vol. 2, No. 3, 1995, pp. 248-254. doi:10.1583/1074-6218(1995)002<0248:AEOAEA>2.0.CO;2
[24]	K. Tokuhiro, Y. Uchida, K. Kawamura, H. Sakuragawa, H. Masuhara, H. Oosawa and N. Koyama, “Evaluation of Annuloaortic Ectasia by Angioscopy and IVUS,” Diagnostic and Therapeutic Endoscopy, Vol. 7, No. 1, 2000, pp. 35-45. doi:10.1155/DTE.7.35
[25]	K. Tsagakis, M. Kamler, J. Benedik and H. Jakob, “Angioscopy—A Valuable Tool in Guiding Hybrid Stent Grafting and Decision Making During Type A Aortic Dissection Surgery,” European Journal Cardio—Thoracic Surgery, Vol. 38, No. 4, 2010, pp. 507-509. doi:10.1016/j.ejcts.2010.02.010
[26]	J. Aono, K. Watanabe, H. Shimizu, H. Higashi, K. Oshima, K. Ishibashi, S. Ikeda and M. Hamada, European Heart Journal, Vol. 28, No. 1, 2007, p. 881.
[27]	S. Hoshino, H. Sadokawa, F. Iwaya, T. Igari, T. Ono and S. Takase, “Externalvalvuloplasty under Preoperative Angioscopic Control,” Phlebologie, Vol. 47, 1993, pp. 521- 529.
[28]	T. Yamaki, K. Sasaki, M. Nozaki. Preoperative duplex-derived parameters and angioscopic evidence of valvular incompetence associated with superficial venous insufficiency. J Endovasc Ther. 2002; 9: 229-233. doi:10.1583/1545-1550(2002)009<0229:PDDPAA>2.0.CO;2
[29]	T. Nishibe, F. Kudo, K. Miyazaki, Y. Kondo, J. Koizumi, A. Dardik and M. Nishibe, “Intermediate-Term Results of Angioscopy-Assisted Anterior Valve Sinus Placation for Primary Deep Venous Insufficiency,” The Journal of Cardiovascular Surgery, Vol. 48, No. 1, 2007, pp. 21-25.
[30]	H. Komai and M. Juri, “Deep Venous External Valvuloplasty Using a Rigid Angioscope,” Surgery Today, Vol. 40, No. 6, 2010, pp. 538-542. doi:10.1007/s00595-009-4076-8
[31]	Y. Uchida, “Angioscopy of Caval Veins,” In: Y. Uchida Ed., Atlas of Cardioangioscopy, Medical View Ltd., Tokyo, 1995, pp. 206-216.
[32]	D. Shure, G. Grigoratos and K. M. Moser, “Fiberoptic Angioscopy. Role in the Diagnosis of Chronic Pulmonary Arterial Obstructions,” American Board of Internal Medicine, Vol. 103, No. 6, 1985, pp. 844-850.
[33]	Y. Uchida, T. Oshma and J. Hirose, “Angioscopic Detection of Residual Pulmonary Thrombi in the Differential Diagnosis of Pulmonary Thromboembolism,” American Heart Journal, Vol. 130, No. 4, 1995, pp. 854-859. doi:10.1016/0002-8703(95)90088-8
[34]	Y. Uchida, Y. Uchida, S. Shirai, T. Oshima, K. Shimizu, T. Tomaru, T. Sakurai and M. Kanai, “Angioscopic Detection of Pulmonary Thromboemboli,” Journal of Interventional Cardiology, Vol. 23, No. 5, 2010, pp. 470-478. doi:10.1111/j.1540-8183.2010.00549.x
[35]	Y. Uchida, “Percutaneous Cardioscopy of Cardiac Chambers and Valves,” In: D. Zipes, Ed., Progress of Cardiology, Lea & Febiger, Boston, 1991, pp.163-192.
[36]	Y. Uchida, “Clinical Application of Percutaneous Cardioscopy for Coronary Heart Disease,” In: Y. Uchida, Ed., Coronary Angioscopy, Futura Publishing Ltd., New York, 2001, pp. 181-233.
[37]	Y. Uchida, F. Nakamura and T. Tomaru, “Observation of Atherosclerotic Lesions by an Intravascular Microscope in Patients with Arteriosclerosis Obliterance,” American Heart Journal, Vol. 130, No. 5, 1995, pp. 1114-1117. doi:10.1016/0002-8703(95)90216-3
[38]	Y. Uchida.Observation of atherosclerosis of peripheral artery by angiomicroscopy. In Y. Uchida, Ed., Atlas of Cardioangioscopy, Medical View Ltd., Tokyo, 1995, pp. 222-224.
[39]	Y. Uchida, T. Sakurai, M. Kanai, S. Shirai and T. Morita, “Characterization of Coronary Fibrin Thrombus in Patients with Acute Coronary Syndrome Using Dye-Staining Angioscopy,” Arteriosclerosis, Thrombosis, and Vascular Biology, Vol. 31, 2011, pp. 1452-1460. doi:10.1161/ATVBAHA.110.221671
[40]	Y. Uchida, Y. Uchida, S. Kawai, R. Kanamaru, Y. Sugiyama, T. Tomaru, Y. Maezawa and N. Kameda, “Detection of Vulnerable Coronary Plaques by Color Fluorescent Angioscopy,” JACC Cardiovasc Imaging, Vol. 3, No. 4, 2010, pp. 398-408. doi:10.1016/j.jcmg.2009.09.030
[41]	Y. Uchida and Y. Maezawa, “Molecular Imaging of Atherosclerotic Coronary Plaques by Fluorescent Angioscopy,” In: B. Schaller, Ed., Molecular Imaging, InTec Open Access Publisher, New York, 2012, pp. 247-268. doi:10.5772/30048
[42]	Y. Uchida and N. Hiruta, “Molecular Imaging of Low-Density Lipoprotein in Human Coronary Plaques by Color Fluorescent Angioscopy,” Proceedings of 26th Annual Meeting of Japanese Association for Cardioangioscopy, Matsuyama, 10 October 2012, p. 53.
[43]	Y. Uchida, “Angioscopy Systems and Their Manipulation,” In: Y. Uchida, Ed., Coronary Angioscopy, Futura Publishing Ltd., Armonk, 2001, pp. 7-24.
[44]	Y. Uchida, F. Nakamura and T. Tomaru, “Rheological Significance of Tandem Lesions of the Coronary Artery,” Heart Vessels, Vol. 10, No. 2, 1995, pp. 106-110. doi:10.1007/BF01744501
[45]	Y. Uchida, T. Tomaru and S. Sumino, “Fiberoptic Observation of Thrombosis and Thrombolysis in Isolated Human Coronary Artery,” Amerocan Heart Journal, Vol. 112, No. 4, 1986, pp. 694-696. doi:10.1016/0002-8703(86)90462-X
[46]	Y. Uchida, “Atlas of Cardioangioscopy,” Medical View, Tokyo, 1995.
[47]	Y. Uchida, “Clinical Classification of Atherosclerotic Coronary Plaques,” In: Y. Uchida, Ed., Coronary Angioscopy, Futura Publishing Ltd., Armonk, 2001, pp. 71-82.
[48]	Y. Uchida, “Peripheral Artery,” In: Y. Uchida, Ed., Atlas of Cardioangioscopy, Medical View, Tokyo, 1995, pp. 190-204.
[49]	Y. Uchida, J. Hirose, M. Kanai, T. Tomaru, H. Noike, S. Morizuki, T. Oshima, K. Kawamura and Y. Fujimori, “Combined Use of Angioscopy and IVUS for Evaluation of Abdominal Aortic Aneurysm before and after Open Repair with Y Graft,” Proceedings of 18th Annual Meeting of Japanese Society of Endovascular Therapy, Tokyo, 20 July 2011, p. 63.
[50]	Y. Uchida, “Venous Disease,” In: Y. Uchida, Ed., Atlas of Cardioangioscopy, Medical View, Tokyo, 1995, pp. 206-216.
[51]	Y. Uchida, M. Kanai, T. Sakurai and K. Tokuhiro, “Aortoscopic Evaluation of Annuloaortic Ectasia,” Proceedings of 17th Annual Meeting of Japanese Society of Endovascular Therapy, Tokyo, 5 July 2010, p. 51.
[52]	Y. Uchida, “Endoscope-Guided Percutaneous Intracardiac and Intravascular Surgery,” In: Y. Uchida, Ed., Atlas of Cardioangioscopy, Medical View, Tokyo, 1995, pp. 226-234
[53]	Y. Uchida, Y. Fujimori, T. Tomaru, T. Oshima and J. Hirose, “Percutaneous Angioplasty of Chronic Obstructions of Peripheral Arteries by Temperature-Controlled Nd:YAG Laser System,” Video Library of Japanese Society of Intravascular Therapy, 1996.
[54]	Y. Uchida, Y. Maezawa, Y. Uchida, N. Hiruta and E. Shimoyama, “Molecular Imaging of Low-Density Lipoprotein in Human Coronary Plaques by Color Fluorescent Angioscopy and Microscopy,” Plos One, Vol. 7, No. 11, 2012, pp. 1-9.