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Specialized Circulations in Susceptible Tissues
Published in Wilmer W Nichols, Michael F O'Rourke, Elazer R Edelman, Charalambos Vlachopoulos, McDonald's Blood Flow in Arteries, 2022
Several catheter-based modalities for coronary plaque imaging have emerged during the last decade. “Virtual histology” uses the ultrasound scattered reflection wave in order to improve tissue characterization by IVUS. “Palpography” or “elastography” is a new IVUS-derived technique used to evaluate the stress–strain relationship on a coronary lesion and to identify thin cap fibroatheroma. Intravascular magnetic resonance imaging (MRI) is a new modality to assess the atherosclerotic burden and the composition of coronary plaques. “Angioscopy” classifies coronary lesions and evaluates their composition by direct visualization of the plaques’ color. “Spectroscopy” (near-infrared and Raman spectroscopy) evaluates the chemical composition of plaque components. “Coronary thermography”, although not strictly an imaging technique, may aid identification of the vulnerable plaque (Stefanadis et al., 1999a). Enthusiasm for all those methods needs to be tempered by the overall perspective of “atherosclerotic disease burden” rather than “the myth of the vulnerable plaque” (Arbab-Zadeh and Fuster, 2015).
The Special Sense Organs and Their Disorders
Published in Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss, Understanding Medical Terms, 2020
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss
Gonioscopy is the examination of the angle of the anterior chamber with a gonioscope (lens) or a contact prism lens and beam illumination from a slit lamp. This procedure is used to detect retinal or optic nerve disease. Applanation tonometry is used to measure intraocular pressure in millimeters of mercury (mmHg). If diagnosis is still in doubt, provocative procedures such as a water drinking test, darkroom test, or mydriatic tests are employed. Other diagnostic procedures may include gross visual fields and basic motor exam, fluorescent angioscopy (examination of the capillary vessels), slit lamp examination, keratometry, ophthalmodynamometry, needle oculo-electromyography, electro-oculography (EOG), and retinoscopy.
Surgical repair of primary deep vein valve incompetence
Published in Peter Gloviczki, Michael C. Dalsing, Bo Eklöf, Fedor Lurie, Thomas W. Wakefield, Monika L. Gloviczki, Handbook of Venous and Lymphatic Disorders, 2017
The results of internal and external valvuloplasty in primary deep valve insufficiency are shown in Tables 43.1 and 43.2. Internal valvuloplasty is credited to have a success rate of over 70% at the 5-year follow-up, and external valvuloplasty on the whole achieved less satisfactory results (40%–50%) if valve competency and freedom from ulceration are taken into account. In all the published series, an excellent correlation can be noted between clinical outcome and valve competency. The outcomes of other techniques are more difficult to assess—either angioscopy-assisted valvuloplasty33–35 or cuffing38–41 (Tables 43.1 and 43.2)—due to the fact that follow-up has not been long enough, with the exception of the series reported by Lane et al.38
Decision making in anomalous aortic origin of a coronary artery
Published in Expert Review of Cardiovascular Therapy, 2023
Hitesh Agrawal, Alexandra Lamari-Fisher, Keren Hasbani, Stephanie Philip, Charles D. Fraser, Carlos M. Mery
Echocardiography generally evaluates the origin of the coronary arteries, ventricular function, and wall motion abnormalities. CTA is useful not only as a confirmatory test but as the imaging modality to define all anatomical details that will help with further decision-making (Figure 2). CTA is used to evaluate the exact origin, course, caliber, and branching pattern of coronary arteries. Images are obtained with retrospective electrocardiography gating and are transferred to a post-processing workstation. Image-reformatting techniques and virtual angioscopy are used for analysis. The standard reading and reporting template used (see above, ‘Nomenclature and classification’) is useful not only for communication within the program but also for longitudinal data collection and communication with other providers.
Ticagrelor versus clopidogrel for prevention of subclinical stent thrombosis detected by optical coherence tomography in patients with drug-eluting stent implantation—a multicenter and randomized study
Published in Platelets, 2021
Xiangqi Wu, Wei You, Zhiming Wu, Qiang Wu, Jun Jiang, Hua Yan, Fei Ye, Shaoliang Chen
Stent thrombosis (ST) is the major cause of stent failure after percutaneous coronary intervention (PCI), often (up to 80% of patients with ST) leading to myocardial infarction (MI) or death [1,2]. With the new generation (cobalt chromium, biodegradable polymer) of drug-eluting stents (DES), late occurrence of ST decreased significantly relative to the first-generation DES, varying from 1% to 3% [3–5]. The mechanisms of ST are affected by many factors, including gene polymorphism, residual drugs, antithrombotic therapy, incomplete stent apposition, lesion stability, presence of permanent polymer, and metallic toxicity, etc. [1–5]. However, locally activated inflammation at the site of uncovered metallic struts is thought to be correlated with ST formation [4,5]. Furthermore, intracoronary angioscopy studies reported a large proportion of subclinical silent ST at the site of uncovered stent struts without endothelialization [6,7]. These results were in line with the findings detected by optical coherence tomography (OCT) [8,9]. It has been reported that unnoticed loss of an unexpanded stent was a known infrequent complication of PCI, which leaded to a chronically lost stent as a result of unendothelialization and subclinical ST after 3 years [10]. Mano and his team have shown that subclinical ST observed by coronary angioscopy in a total of 248 second-generation DES in 179 patients at 9 months was independently associated with poor clinical outcome [11]. Totally, these results revealed that how to effectively prevent and treat subclinical ST will become a challenge project.
Histopathologic and physiologic effect of overlapping vs single coronary stents: impact of stent evolution
Published in Expert Review of Medical Devices, 2018
Atsushi Sakamoto, Sho Torii, Hiroyuki Jinnouchi, Renu Virmani, Aloke V. Finn
To date, most preclinical studies in animal models such as those in normal swine and rabbits using the overlapping configuration demonstrated delayed healing at overlapping sites as compared to single stents. In diseased human coronary arteries, pathologic studies comparing patients presenting with acute myocardial infarction (AMI) to those with stable angina treated with first-generation DES have shown delayed vascular healing at culprit sites of AMI as compared to stable angina culprit sites. This was also confirmed using angioscopy in living patients. However, second-generation DES has attenuated this discrepancy, although some differences still remain.