極限ファイバースコープに向けて

Abstract

Objective: Angioscopy has proved to provide more detailed information on lesion morphology than angiography. Therefore, to evaluate the effects of vascular interventions, angioscopy was performed in 68 patients with peripheral or coronary artery disease who underwent interventions.Methods and results: PTCA: Angioscopy was performed in 29 patients who underwent PTCA. The characteristics of angioscopic findings after PTCA consisted of cleft, fractures of plaques, intimal bleeding, exfoliation of endothelium and thin mural thrombi. Thermal laser anigoplasty: Angioscopy was performed 12 patients who underwent laser thermal angioplasty. Laser thermal angioplasty was performed with a Nd:YAG laser system equipped with a probe temperature programmable microprocessor that could monitor and control probe temperature simultaneously. Coagulation and carbonization were observed, when the probe temperature was over loot and 200°C, respectively. Excimer laser anigioplasty: Angioscopy was performed in 2 patients with peripheral and 25 patients with coronary artery disease who underwent excimer laser angioplasty. The excimer laser was operated at 308 nm, 135 nsec, 25 Hz and 40-60mJ/mm2 and was coupled into multifiber wire-guided catheters. The characteristics of angioscopic findings after excimer laser angioplasty consisted of flaps, fractures of plaques and abundant tissue remnants. There was no apparent thermal injury.Conclusions: These results indicate that 1) angioscopy is effective and safe for evaluation of lesion morphology after interventions, 2) excimer laser ablation does not result in thermal injury, which is commonly observed after thermal laser ablation, 3) irregular channels after recanalization and abundant tissue remnants may explain the suboptimal results after excimer laser angioplasty, and 4) all interventions may result in the same kind of mechanical vascular wall damage.