Fluffy Luminal Surface of the Non-Stenotic Culprit Coronary Artery in Patients With Acute Coronary Syndrome  - An Angioscopic Study -

Uchida, Yasumi; Uchida, Yukiko; Sakurai, Takeshi; Kanai, Masahito; Shirai, Seiichiro; Oshima, Tadayuki; Koga, Atsushi; Matsuyama, Akimasa; Tabata, Tsuyoshi

doi:10.1253/circj.cj-10-0422

Cited by 7 publications

(7 citation statements)

References 19 publications

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“…14,15 Histological examinations in animals and patients revealed that this dye stains fibrin and damaged endothelial cells but not blood corpuscles. 10,[11][12][13] Discrimination of endothelial flap and globular thrombus was made according to the criteria described in the guidelines. 10 After observation by conventional angioscopy, 1 mL of 2.5% EB solution was injected during balloon inflation into the artery through the flush channel of the angioscope to stain the thrombus, and then the balloon was deflated for blood flow restoration.…”

Section: Dye-staining Angioscopy Proceduresmentioning

confidence: 99%

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Characterization of Coronary Fibrin Thrombus in Patients With Acute Coronary Syndrome Using Dye-Staining Angioscopy

Uchida

Sakurai

et al. 2011

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Objective-Because fibrin is transparent and almost invisible by any conventional imaging methodologies, clinical examinations of coronary fibrin thrombus have been ignored, and little is known about its role in the genesis of acute coronary syndrome (ACS). The present study was performed to visualize coronary fibrin thrombus and to examine its role in ACS. Methods and Results-Dye-staining coronary angioscopy using Evans blue dye, which selectively stains fibrin blue but does not stain blood corpuscles, was performed for observation of globular coronary thrombi in 111 ACS patients. The thrombi were aspirated for histological examination. The thrombi were classified by visual appearance into 8 transparent, 3 light-red, 2 frosty glass-like and membranous, 32 white, 8 brown, 34 red, and 19 red-and-white in a mosaic pattern. Transparent thrombi that were not visible by conventional angioscopy were visualized as a blue structure by dye-staining angioscopy, and they were observed in patients with unstable angina (UA) and non-ST elevation myocardial infarction (NSTEMI). The thrombi caused total or subtotal coronary occlusion. The aspirated thrombi were composed of fibrin alone by histology. Fibrin-rich thrombi were visualized using dye-staining angioscopy in 60% of 50 patients with UAϩNSTEMI and in 29% of 61 patients with ST-elevation myocardial infarction. By histology of the aspirated thrombi, fibrin-rich thrombi were observed in 71% of 33 patients with UAϩNSTEMI and in 28% of 35 patients with ST-elevation myocardial infarction. Conclusion-Fibrin-rich coronary thrombi were frequently observed by both dye-staining angioscopy and histology in ACS patients. Rarely, fibrin itself formed a globular thrombus and caused coronary occlusion. (Arterioscler Thromb

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Section: Dye-staining Angioscopy Proceduresmentioning

confidence: 99%

“…9,10 The present dyestaining angioscopic study was therefore performed to visualize fibrin in coronary thrombus and to examine the roles of fibrin in the genesis of ACS.…”

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Characterization of Coronary Fibrin Thrombus in Patients With Acute Coronary Syndrome Using Dye-Staining Angioscopy

Uchida

Sakurai

et al. 2011

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“…Histologically, the fluffy surface was composed of fibrin threads arising from the damaged ECs and adhered together by platelets. Therefore, it is proposed that a coronary segment with a fluffy or frosted glass-like surface is the site of surface disruption, and resultant thrombosis and the changes are related to residual fibrin and platelets after autolysis of the thrombus [17]. …”

Section: Dye-staining Coronary Asmentioning

confidence: 99%

Dye-Staining Angioscopy for Coronary Artery Disease

Uchida

2015

Curr Cardiovasc Imaging Rep

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Novel imaging techniques using biomarkers have clarified the mechanisms of hitherto unanswered or misunderstood phenomena of coronary artery disease and enabled evaluation of myocardial blood and tissue fluid flows in vivo. Dye-staining coronary angioscopy using Evans blue (EB) as the biomarker can visualize fibrin and damaged endothelial cells, revealing that the so-called platelet thrombus is frequently a fibrin-rich thrombus; occlusive transparent fibrin thrombus, but not platelet thrombus, is not infrequently a cause of acute coronary syndrome; “fluffy” coronary luminal surface is caused by fibrin threads arising from damaged endothelial cells and is a residue of an occlusive thrombus after autolysis in patients with acute coronary syndrome without angiographically demonstrable coronary stenosis; and web or membrane-like fibrin thrombus is a cause of stent edge restenosis. Fluorescent angioscopy using visual or near-infrared light wavelengths is now used clinically for molecular imaging of the substances such as lipoproteins and cholesterol that constitute coronary plaques. Dye-staining cardioscopy using EB or fluorescein enables direct and real-time visualization of subendocardial microcirculation.

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“…The same mechanisms may participate in patients with ACS without significant coronary stenosis, or without demonstrable plaque disruption. However, the genesis of endothelial damage remains to be elucidated [29]. Extensive endothelial cell apoptosis induced through catecholamine-␤-adrenoceptorcaspase pathway [30] may play a role in this phenomenon.…”

Section: Acute Coronary Syndromes Without Obvious Coronary Plaque Disruptionmentioning

confidence: 99%

Recent advances in coronary angioscopy

Uchida¹

2011

Journal of Cardiology

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Angioscopy enables macroscopic pathological diagnosis of cardiovascular diseases from the inside. This imaging modality has been intensively directed to characterizing vulnerable coronary plaques. Scoring of plaque color was developed, and based on prospective studies; dark yellow or glistening yellow plaques were proposed as vulnerable ones. Colorimetry apparatus was developed to assess the yellow color of the plaques quantitatively. The effects of lipid-lowering therapies on coronary plaques were confirmed by angioscopy. However, since observation is limited to surface color and morphology, pitfalls of this imaging technology became evident. Dye-staining angioscopy and near-infrared fluorescence angioscopy were developed for molecular imaging, and the latter method was successfully applied to patients. Color fluorescence angioscopy was also established for molecular and chemical basis characterization of vulnerable coronary plaques in both in vitro and in vivo. Drug-eluting stents (DES) reduce coronary restenosis significantly, however, late stent thrombosis (LST) occurs, which requires long-term antiplatelet therapy. Angioscopic grading of neointimal coverage of coronary stent struts was established, and it was revealed that neointimal formation is incomplete and prevalence of LST is higher in DES when compared to bare-metal stent. Many new stents were devised and they are now under experimental or clinical investigations to overcome the shortcomings of the stents that have been employed clinically. Endothelial cells are highly anti-thrombotic. Neoendothelial cell damage is considered to be caused by friction between the cells and stent struts due to the thin neointima between them that might act as a cushion. Therefore, development of a DES that causes an appropriate thickness (around 100 μm) of the neointima is a potential option with which to prevent neoendothelial cell damage and consequent LST while preventing restenosis.

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Fluffy Luminal Surface of the Non-Stenotic Culprit Coronary Artery in Patients With Acute Coronary Syndrome - An Angioscopic Study -

Cited by 7 publications

References 19 publications

Characterization of Coronary Fibrin Thrombus in Patients With Acute Coronary Syndrome Using Dye-Staining Angioscopy

Characterization of Coronary Fibrin Thrombus in Patients With Acute Coronary Syndrome Using Dye-Staining Angioscopy

Dye-Staining Angioscopy for Coronary Artery Disease

Recent advances in coronary angioscopy

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