Exploring inside a shaggy aorta using non-obstructive angioscopy

Abstract

A shaggy aorta is reportedly related to atheromatous embolisation, which causes serious ischaemic damage to various organs. However, its characteristics are poorly understood. Non-obstructive angioscopy (NOA) has been developed to safely detect aortic plaques and injuries. A 70-year-old woman who was found to have a shaggy aorta on CT angiography underwent NOA for precise evaluation of vulnerable aortic plaques and injuries inside the aorta. Vulnerable aortic plaques included puff-like ruptures, chandelier-like ruptures and erosions seen throughout the aorta. Aortic injuries included flaps, slits, subintimal bleeding, dissection and multilayered partitions. The patient had no embolic symptoms or an elevated eosinophil count, estimated glomerular filtration rate or C reactive protein level, compared with the baseline. Various changes in spontaneous vulnerable plaques and injuries inside the aorta that were not apparent on CT were safely revealed on NOA. Thus, NOA may reveal findings indicative of spontaneous and postoperative atheromatous embolisation.

Observation of an Asymptomatic Dissecting Aortic Aneurysm Using Non-Obstructive Angioscopy

“…2) In this case, we used aortic angioscopy with a system similar to that used in previous studies to identify aortic atheromatous plaques. 2,7) Aortic angioscopy showed many ruptured plaques, red thrombi, and yellow plaques throughout the aorta (Figure 3). Furthermore, aortic angioscopy demonstrated a great fissure in the severe atheromatous plaques around the entry tear of the dissecting aortic aneurysm (Figure 4).…”

“…[1][2][3] The cause of aortic dissection has not been fully elucidated. Nonobstructive angioscopy for the aorta is a new modality that may have higher reliability identifying atherosclerosis of the aortic wall because of its higher spatial resolution compared with CT. 2,[5][6][7] Non-obstructive angioscopy is expected to contribute to elucidating the prediction of aortic disease onset. 2)…”

Spontaneous Ruptured Aortic Plaques and Injuries Detected using Non-obstructive General Angioscopy

“…Applying NOGA to the aorta NOGA is a technology used to screen the inner aspect of vessels regardless of their size. It can simultaneously screen the coronary 9) , renal 10) , and pulmonary 11) arteries and the aorta 12,13) . Initially, this technology was used to analyze coronary artery plaques and stents 9,14) .…”

“…Various types of SRAPs have been detected ( Fig. 1) 1,12,13,[20][21][22][23][24] . The normal aortic intima is white with a smooth surface ( Fig.…”

“…Puff ruptures are defined as white or white-yellow puff-like materials, which can easily blow out ( Fig. 2B) 1,13) . A chandelier appearance indicates an intimal change, which is glistening against light from the tip of the angioscopic fiber catheter, wriggling but not blown out ( Fig.…”