Non-obstructive Angioscopy Research Articles

Direct visualization of cardiac and pulmonary artery tumors and intracardiac biopsy with non-obstructive general angioscopy.

Direct visualization of cardiac and pulmonary artery tumors and intracardiac biopsy with non-obstructive general angioscopy.

Association Between Aortic Wall Parameters on Multidetector Computed Tomography and Ruptured Plaques By Nonobstructive General Angioscopy.

Nonobstructive general angioscopy (NOGA) can identify vulnerable plaques in the aortic lumen that serve as potential risk factors for cardiovascular events such as embolism. However, the association between computed tomography (CT) images and vulnerable plaques detected on NOGA remains unknown. We investigated 101 patients (67±11 years; women, 13.8%) who underwent NOGA and contrast-enhanced CT before or after 90 days in our hospital. On CT images, the aortic wall thickness, aortic wall area (AWA), and AWA in the vascular area were measured at the thickest point from the 6th to the 12th thoracic vertebral levels. Furthermore, the association between these measurements and the presence or absence of NOGA-derived aortic plaque ruptures (PRs) at the same vertebral level was assessed. NOGA detected aortic PRs in the aortic lumens at 145 (22.1%) of the 656 vertebral levels. The presence of PRs was significantly associated with greater aortic wall thickness (3.3±1.7 mm versus 2.1±1.2 mm), AWA (1.33±0.68 cm2 versus 0.89±0.49 cm2), and AWA in the vascular area (23.2%±9.3% versus 17.2%±7.6%) (P<0.001 for all) on the CT scans compared with the absence of PRs. The frequency of PRs significantly increased as the aortic wall thickness increased. Notably, a few NOGA-derived PRs were detected on CT in near-normal intima. The presence of NOGA-derived PRs was strongly associated with increased aortic wall thickness, AWA, and AWA in the vascular area, measured using CT. NOGA can detect PRs in the intima that appear almost normal on CT scans.

Different Characteristics and Interleukin-6 Ratios of Scattering-Type Aortic Plaques.

Background Cholesterol crystals (CCs) are related to innate inflammation in spontaneously ruptured aortic plaques (SRAPs), and variability exists in the CCs and interleukin (IL)-6 ratio in SRAPs. Methods The prevalence of scattering-type ruptures that glittered against the light of angioscopic fibers (puff-chandelier ruptures) and those that did not (puff ruptures) was analyzed in 848 patients with suspected coronary artery disease. Overall, 177 puff-chandelier ruptures and 105 puff ruptures were sampled using nonobstructive general angioscopy (NOGA). The sampled plaques were analyzed by direct detection of CCs with polarized light microscopy. The characteristics of the plaque fragments from puff and puff-chandelier ruptures were compared. The Interleukin-6 (IL-6) ratios were calculated for 100 puff-chandelier ruptures and 100 puff ruptures. Results CCs were detected in 54% of puff-chandelier ruptures and 20% of puff ruptures. The longer and shorter dimensions of the puff ruptures were smaller than those of the puff-chandelier ruptures. CCs were more prevalent in puff chandeliers than in puff ruptures (54% vs. 20%, respectively; p<0.0001). The number of CCs was higher in puff chandeliers than in puff ruptures with CCs (median 12,727 (interquartile range (IQR) 3,636-25,909)/10 mL vs. median 3,182 ( IQR 909-9,318)/10 mL) in CC-positive samples (p=0.0120). The IL-6 ratio of puff-chandelier ruptures was higher than that of puff ruptures (p=0.0014). Conclusions Examination of plaque fragments from puff-chandelier and puff ruptures revealed a higher prevalence of CCs in puff-chandelier ruptures compared to puff ruptures. Puff chandeliers exhibited a significantly greater number of CCs, suggesting a potential correlation with inflammatory levels. The IL-6 ratio was also higher in puff-chandelier ruptures. Direct detection of CCs and hematoxylin and eosin staining for SRAPs demonstrated variations in CC degree and dimensions between puff-chandelier and puff ruptures. Puff-chandelier ruptures exhibited more CCs associated with innate inflammation and larger fragments than puff ruptures. NOGA proved effective in detecting diverse characteristics and inflammation levels, as indicated by IL-6, in scattering-type SRAPs.

Association between aortic thrombi detected using non-obstructive general angioscopy and atrial fibrillation.

Atrial fibrillation (AF) is an independent risk factor for stroke and systemic embolism. Cardiogenic and aortogenic emboli are causes of stroke or systemic embolism. Non-obstructive general angioscopy (NOGA) can be used to diagnose aortic intimal findings, including thrombi and atherosclerotic plaques, but little is known about NOGA-derived aortic intimal findings in patients with AF. This study focused on aortic intimal findings in patients with AF and evaluated the association between AF and aortic thrombi detected using NOGA. We enrolled 283 consecutive patients with coronary artery disease who underwent NOGA of the aorta between January 2017 and August 2022. Aortic intimal findings were screened using NOGA after coronary arteriography. The patients were divided into two groups according to their AF history (AF, n = 50 and non-AF, n = 233). Patients in the AF group were older than those in the non-AF group. Sex, body mass index, and coronary risk factors were not significantly different between the two groups. In the NOGA findings, the presence of intense yellow plaques and ruptured plaques was not significantly different between the two groups. Aortic thrombi were more frequent in the AF group than in the non-AF group (92.0 vs. 71.6%, p < 0.001). Multivariate logistic regression found that AF was independently associated with aortic thrombi (odds ratio 3.87 [95% CI 1.28-11.6], p = 0.016). The presence of aortic thrombi observed using NOGA was associated with AF in patients with coronary artery disease. The roles of aortic thrombi as well as cardiogenic embolism may require clarification.

Cholesterol crystals as the main trigger of interleukin-6 production through innate inflammation in human spontaneously ruptured aortic plaques

Abstract Aim Cholesterol crystals (CCs) may provoke innate inflammation in experimental and animal model, however, whether CCs are bystanders or play central role for plaque rupture is unknown. This study aimed to clarify whether CCs was the main trigger of innate inflammation in human spontaneously ruptured aortic plaques (SRAPs). Methods This study included 260 SRAPs collected during non-obstructive general angioscopy (NOGA) from 126 patients with having or suspected CAD. Interleukin (IL)-6 levels in SRAPs were measured. IL-6 level at the Valsalva sinus, and femoral or brachial arteries were measured. IL-6 ratios, IL-6 level in SRAPs and arteries divided by IL-6 level at the Valsalva sinus at the beginning of aorta, were calculated. The number of CCs were counted in sampled blood. The correlation between the count of CCs and IL-6 levels in SRAPs and that between the counts of CCs and IL-6 ratios in SRAPs were analyzed. Results IL-6 ratios of the brachial and femoral arteries were 1.06 (95% CI, 0.99–1.20) and 1.11 (95% CI, 1.04–1.20), respectively. IL-6 ratio in SRAPs was 1.10 [1.00, 1.26]. (median [IQR]). CCs were detected in 94 of 260 SRAPs (36%). The count of CCs was 11,590 (95% CI: 2,386–30,113] per 10 mL in CCs positive samples. There was a moderate correlation between the counts of CCs and IL-6 ratios in SRAPs (r=0.496, r&amp;lt;0.0001)(Fig. 1), whereas there was no correlation between the count of CCs and IL-6 levels in SRAPs.(Fig. 2) Conclusions By the in-situ study, CC might be the main trigger of IL-6 through innate inflammation in human SRAPs.Fig 1Fig 2

Abstract 14105: Impact of Aortic Atheromatous Plaques Identified by Aortic Angioscopy on Five-Year Clinical Events: Novel Evaluation by Non-Obstructive General Angioscopy Registry

Introduction: Non-obstructive general angioscopy (NOGA) has become a novel method of evaluating atheromatous plaques of the aortic intimal wall. Aortic atheromatous plaques are potentially related to future cardiovascular events, but these associations remain undetermined regarding long-term follow-up. Methods: We conducted a multicenter, observational, prospective registry of consecutive 577 patients with confirmed or suspected coronary artery disease underwent NOGA at 13 centers in Japan and counted atheromatous plaques from aortic cusp to terminal aorta with intra-aortic scan of NOGA. All patients were divided into three groups based on the tertile of the number of aortic atheromatous plaques. The relationships between aortic atheromatous plaques and clinical events after five-year follow-up were evaluated. Results: The median number of aortic atheromatous plaques was 6 [IQR: 3-12]. The mean follow-up duration was 1860 ± 860 days. At five-year follow-up, the incidence of major adverse cardiovascular events (MACE) (cardiovascular death, non-fatal myocardial infarction, cerebral infarction, or peripheral artery disease) was significantly higher in the higher tertile group (lower tertile 7.4% vs. middle 13.2% vs. higher 20.7%, p&lt;0.001, respectively). Kaplan-Meier analysis demonstrated a significantly higher probability of MACE in higher tertile group of all (log-rank test: p &lt; 0.001). Conclusions: Aortic atheromatous plaques identified by NOGA could be vulnerable, and thus were strongly associated with clinical events during five-year follow-up.

Abstract 12048: Aortic Vulnerable Plaques Including Cholesterol Crystals: Non-Obstructive General Angioscopy and Pathological Study

Introduction: Severe atherosclerosis of the aorta is known to be a risk of embolism to peripheral organs such as cerebral infarction and acute lower limb ischemia. Non-obstructive general angioscopy (NOGA) has high spatial and temporal resolution, and it is possible to dynamically observe various atherosclerosis in the aorta. Cholesterol crystals (CCs) which could be observed by NOGA scattered into the blood from ruptured plaques and caused inflammation. However, which NOGA-derived aortic plaques are high risk has not fully investigated yet. Aims: The purpose of our study was to evaluate aortic vulnerable plaques based on their frequency of scattering CCs. Methods: We investigated 52 consecutive patients with coronary artery disease who underwent NOGA between September 2021 and May 2023. Blood specimens were taken from a total of 118 NOGA-derived atheromatous plaques in the infrarenal abdominal aorta. Then, presence of CCs at each plaque was evaluated with polarized light microscopy using the filter paper rinse method. Results: The mean age of 52 patients in this study was 67.4 years, 82.7% were male, 36.5% had diabetes, 76.9% had dyslipidemia, and 82.7% had hypertension. CCs were detected in 28.8% (n=34/118) of the samples. The frequency of detection of CCs in aortic plaques was 52.5% for Puff Chandelier Rupture (PCR), 15.4% for Puff Rupture (PR), 4.5% for yellow plaques (YP), 0% for thrombi, and 0% for ulcer and fissure. P &amp;lt; 0.0001). Conclusions: Among aortic atherosclerotic plaques, many CCs were detected from PCR. PCR may be a vulnerable plaque that has a high impact on peripheral organs.

Demonstrating an Adult Ventricular Septal Defect Using Non-obstructive General Angioscopy

A ventricular septal defect (VSD) is a common congenital heart disease, and the transcatheter technique for VSD requires practical guidance because it requires a complicated procedure. A non-obstructive angioscopy catheter system via the right ventricle successfully revealed an approximately 3-mm VSD with the shape of a rugby ball at the center of the white membranous septum of Kirklin type II in an older female with suspected coronary artery disease. A white membranous terraced septum was observed to be surrounded by a reddish ventricle. Conservative therapy was performed for her VSD because she did not meet the criteria for surgical treatment.

Abstract 15650: Relationship Between Lipoprotein (a) and Aortic Vulnerable Plaques Detected by Non-Obstructive General Angioscopy

Background: Although atherosclerotic disease including myocardial infarction had decreased with lipid-lowering therapy for LDL cholesterol, atherosclerotic risk factors as residual risks without low-density lipoprotein are pointed out. Especially, lipoprotein (a) had been reported as one of the cardiovascular risks. Non-obstructive general angioscopy (NOGA) can meticulously visualize directly aortic atherosclerosis. NOGA-derived aortic vulnerable plaques had been reported to be related to future cardiovascular events. However, the relationships between serum lipoprotein (a) value and NOGA-derived aortic plaques had not been fully investigated yet. Methods and Results: We investigated consecutive 165 cases with coronary artery disease evaluated for the aorta by NOGA. Atherosclerotic lesions of the aorta were screened using NOGA immediately after coronary arteriography. NOGA examination evaluated the presence of aortic ruptured plaques which were "puff-chandelier rupture" appearance as previously reported. The mean age was 68 years and the median lipoprotein (a) value was 16 [9-27]. The median number of plaque ruptures was 1 [0-3], and 60% of cases had at least one plaque rupture. In a logistic regression analysis for the presence of aortic plaque rupture, the serum lipoprotein (a) value was associated with NOGA-derived aortic plaque rupture (odds ratio, 1.01 [1.0-1.03], p &lt; 0.05). The study patients were divided into three groups according to the tertile of serum lipoprotein (a) value [1st tertile: 0-11 mg/dl, 2nd tertile: 12-24 mg/dl, 3rd tertile 25 mg/dl &lt;], the first tertile had the lowest prevalence of plaque rupture (the presence of plaque rupture: first tertile 50%, second tertile 71%, third tertile 72%, p = 0.03). Conclusion: Serum lipoprotein (a) value was related to the presence of the aortic plaque rupture. Further studies are needed to elucidate the effect of the low lipoprotein (a) on the prevention of aortic vulnerable plaques.

Abstract 10040: Impact of Periaortic Adipose Tissue Detected by Computed Tomography on Aortic Vulnerable Plaques Identified by Non-Obstructive General Angioscopy

Introduction: Periaortic adipose tissue (PAAT) is related to the development of cardiovascular disease. However, the relationship between periaortic adipose tissue (PAAT) and aortic plaque instability has not been elucidated. Hypothesis: We hypothesized that PAAT would be associated with aortic vulnerable plaques derived non-obstructive general angioscopy (NOGA) in patients with cardiovascular disease. Methods: We investigated 117 patients who underwent NOGA of the aorta and CT. PAAT volume was measured using the volume-rendering method by extracting the area from -30 to -190 HU within the thoracic aorta. PAAT volume index (PAAT-I) was defined as PAAT volume divided by the body surface area. We evaluated the number of vulnerable plaques including ruptured plaques, ulcerations, thrombi, intense yellow plaques by NOGA in the whole aorta. All patients were divided into the median value of PAAT-I (16.9 [13.0 - 21.6] ml/m2) Results: The high PAAT-I patients had significantly greater number of vulnerable plaques in the thoracic aorta than the low PAAT-I patients (2 [1-4] vs 1 [0-3], p&lt;0.05). The PAAT-I had a correlation with the number of vulnerable plaques in the thoracic and whole aorta (r=0.44, p&lt;0.001, r=0.35, p&lt;0.01, respectively) Conclusions: PAAT in the thoracic aorta was related to the number of NOGA derived-aortic vulnerable plaques in patients with cardiovascular disease. PAAT may play an important role in the development of aortic plaque instability.

Significant Contribution of Aortogenic Mechanism in Ischemic Stroke: Observation of Aortic Plaque Rupture by Angioscopy.

Although embolic stroke accounts for most cerebral infarction, examinations to identify the embolic source have been insufficient. Nonobstructive general angioscopy (NOGA) has developed to allow the detailed observation of atheromatous changes of the aorta. The purpose of this study was to clarify the importance of the aortogenic mechanism in the development of ischemic stroke. We examined 114 consecutive patients whose aorta was observed by NOGA and who subsequently underwent brain magnetic resonance imaging to detect ischemic stroke lesions. In the evaluation of the aorta, the presence and location of spontaneously ruptured aortic plaque (SRAP) were determined. The aorta was observed from the origin to the arch (proximal aorta [PAo]) and the proximal descending aorta. Forty-nine of 114 patients had SRAP observed by NOGA. Among these, 24 had SRAP in the PAo, and 43 had SRAP in the descending aorta. Thirty-three patients had ischemic stroke lesions, including 6 with a clinical neurologic deficit. The frequency at which SRAP was detected in these patients was significantly higher in comparison to 81 patients without ischemic stroke (69% vs 33%; P< 0.01). The sensitivity and specificity of the presence of SRAP for ischemic stroke were 0.70 and 0.68, respectively. The presence of SRAP in PAo was significantly correlated with ischemic stroke (odds ratio: 14.3; P< 0.001). In the treatment of ischemic stroke, attention should be paid to SRAP, especially that in the PAo.(STROKE-NOGA [SponTaneously Ruptured aOrtic plaques as a potential cause of embolic stroKEs visualized by Non-Obstructive General Angioscopy] Study; UMIN000034588).

Diversity in the characteristics of spontaneous ruptured aortic plaques

Abstract Background Spontaneous ruptured aortic plaques (SRAPs) act as emboli for systemic organs because SRAPs might contain CCs which cause inflammation besides mechanical obstruction. The purpose of the study is to clarify the difference of the characteristics of representative SRAPs, puff rupture and puff-chandelier rupture sampled by non-obstructive general angioscopy. (NOGA) Methods A total of 177 puff-chandelier ruptures which blown out spontaneously and glittered against the light of the angioscopic fiber and 105 puff ruptures which did not glitter were sampled by NOGA in patients having or suspected coronary artery disease. Sampled plaques were analyzed two kinds of methods, conventional Hematoxylin-eosin stain and methods without solvents. Samples were diagnosed if the component of atheroma was detected with either method. The percentage of content of CCs, the number of CCs, the longer and shorter diameters were compared between blood sampled from puff and puff-chandelier rupture. Results Samples were diagnosed as atheroma 56% of puff-chandelier rupture and 27% of puff- rupture. (p&amp;lt;0.0001) Higher number of CCs was included in puff-chandelier rupture than in puff-rupture. (12,955 [3,977, 25,795] vs. 3,182 [909, 7,273]) The longer and shorter diameters of plaque components of puff rupture were smaller than those of puff-chandelier rupture. (p=0.0259 and p=0.0286, respectively.) CCs were tended to be included puff-chandelier rupture than puff-rupture. (53% vs. 16%, respectively; p&amp;lt;0.0001) Visible debris was obtained only 13% of puff rupture and 26% of puff-chandelier rupture. Conclusions Diversity of SRAPs were shown as that puff rupture had less CCs and more fibrin than puff-chandelier rupture, suggesting that potentially less inflammation and more fibrinolytic. Funding Acknowledgement Type of funding sources: None.

Continuous 1-Month Release of Cholesterol Crystals in a Patient With Acute Coronary Syndrome After Stenting

Coronary stenting was performed for a 76-year-old patient with acute coronary syndrome with severe stenosis of the right coronary artery. Puff rupture including cholesterol crystals was detected on nonobstructive general angioscopy. One month after intervention, continuous release of cholesterol crystals was found despite successful percutaneous coronary intervention. (Level of Difficulty: Intermediate.)

Efficacy of non-obstructive aortic angioscopy for detecting a thoracic aortic graft rupture: a case report

BackgroundNon-anastomotic thoracic aortic graft rupture is extremely rare and difficult to diagnose. Non-obstructive general angioscopy can help monitor the aortic intima and detect the locations of abnormal findings, while aortic angioscopy can detect vulnerable plaques in the aorta, which are difficult to visualize using conventional diagnostic methods. Herein, we report the case of a patient with non-anastomotic thoracic aortic graft rupture diagnosed using non-obstructive aortic angioscopy.Case presentationAn 85-year-old man who had undergone total arch replacement 5 years prior complained of chest pain. Emergent contrast-enhanced computed tomography (CT) revealed an intra-mediastinal hematoma around the vascular graft of the ascending aorta and angiography revealed pooling of contrast medium on the dorsal side of the vascular graft. We suspected extravasation of the thoracic vascular graft. Aortic angioscopic examination revealed a red vascular graft defect that matched extravasation at the contralateral level of the prosthetic left common carotid artery branch. Subsequently, non-anastomotic thoracic aortic graft rupture was diagnosed. The patient underwent a two-debranching thoracic endovascular aortic repair (Zone 0) with a right subclavian artery-left common carotid artery-left subclavian artery bypass. Postoperative angiography revealed disappearance of the extravasation from the graft rupture site, patent grafted vessels with flow, and no endoleak. Follow-up CT at 6 months postoperatively showed no extravasation.ConclusionsTo our knowledge, this is the first report of non-anastomotic thoracic aortic graft rupture detected using non-obstructive aortic angioscopy. Aortic angioscopy can help establish a definitive diagnosis in patients with aortic graft rupture.

Debris collected in-situ from spontaneously ruptured atherosclerotic plaque invariably contains large cholesterol crystals and evidence of activation of innate inflammation: Insights from non-obstructive general angioscopy

Background and aimsDevelopment and expansion of cholesterol crystals (CCs) within a lipid rich atherosclerotic core are believed to predispose to plaque rupture. We have used non-obstructive general angioscopy to described a range of appearances of spontaneously ruptured atherosclerotic plaques (SRAPs) in the aorta in-situ, and have confirmed that debris extruding from some SRAPs (puff-chandelier lesions) are rich in cholesterol crystals and leukocytes. The purpose of this study was to characterized the nature of the inflammatory infiltrate of this debris. MethodsDebris was collected from puff-chandelier lesions at the time of angioscopy in patients with known coronary disease. Prepared specimens were examined by light microscopy, and immunostaining was used to detect markers of activation of the innate inflammatory pathway including CD68, NLRP3, caspase-1, IL-1β, IL-18, and IL-6. ResultsWe analysed debris sampled from 20 puff-chandelier lesions. Microscopy confirmed the presence of large CCs, macrophages, fibrin, calcified gruel, lymphocytes, and neutrophils in 100%, 100%, 95%, 25%, 20%, and 15% of the specimens respectively. Immunostaining confirmed the presence of CD68, NLRP3, IL-1β, and IL-6 within the debris in 100%, 90%, 80%, and 80%, of the specimens respectively. CCs, NLRP3, caspase-1, IL-1β, IL-18, were also identified in the cytoplasm of macrophages. ConclusionsDebris from SRAPs with a puff-chandelier appearance invariably contained large CCs associated with a range of activated leukocytes involved in innate inflammation. This observation supports the thesis that the development and enlargement of CCs in the core of lipid rich plaques may precipitate traumatic and inflammatory injury that may lead to plaque rupture.

Serial Observation of Aortic Puff-Chandelier Rupture for 2 Years by Non-Obstructive General Angioscopy

Serial Observation of Aortic Puff-Chandelier Rupture for 2 Years by Non-Obstructive General Angioscopy

Aortic plaque burden predicts vascular events in patients with cardiovascular disease: The EAST-NOGA study

BackgroundNon-obstructive general angioscopy (NOGA) can be used to diagnose aortic atherosclerotic plaques. We examine the association between the number of aortic plaques detected by NOGA and the risk of subsequent cardiovascular events. MethodsThe Evaluation of AtheroScleroTic and rupture events by Non-Obstructive General Angioscopy (EAST-NOGA) was a prospective cohort study of patients with suspected coronary artery disease who underwent NOGA. ResultsOf the 577 patients who underwent NOGA, 532 (92%) completed the follow-up (median follow-up: 13 months, interquartile range: 12-16). The median number of plaques per person was 6 (interquartile range: 3-12), and 567 (98%) had at least one aortic plaque. During the 13-month follow-up, 38 (7.1%) patients had a primary composite endpoint [including cardiovascular death, myocardial infarction, stroke, peripheral artery disease (PAD), or worsening renal function], which was significantly associated with chronic kidney disease, a history of PAD, a lower hemoglobin level, and large numbers of aortic plaques [11 (5-17) vs. 6 (2-11), p = 0.003]. A receiver operating characteristic curve analysis for the number of aortic plaques predicting composite endpoints revealed that the cut-off value of aortic plaques was 12. After multivariate adjustment, the presence of ≥12 aortic plaques remained a significant predictor for composite endpoint events (hazard ratio 2.53, 95% confidence interval 1.26-5.04, p = 0.010). ConclusionsThe number of aortic plaques detected by NOGA may predict subsequent clinical events.

Renal Artery Fibromuscular Dysplasia Observed on Nonobstructive Angioscopy.

Renal Artery Fibromuscular Dysplasia Observed on Nonobstructive Angioscopy.

Intravascular aortic observation by non-obstructive general angioscopy in Treponema pallidum syphilis.

Intravascular aortic observation by non-obstructive general angioscopy in Treponema pallidum syphilis.

Multiple Intimal Injuries of Chronic Aortic Dissection Observed by Non-Obstructive General Angioscopy.

Multiple Intimal Injuries of Chronic Aortic Dissection Observed by Non-Obstructive General Angioscopy.