The use of nonobstructive general angioscopy allowed to visualize the aortic intima and detect abnormal conditions prior to thoracic endovascular repair (TEVAR) of chronic type B aortic dissection, according to study results published in the Journal of Cardiology.
Aortic angioscopy is considered a valuable tool for the identification of areas of vulnerable plaque or intimal injury, which are not always detected on computed tomography (CT).
Ten patients (mean age, 69±13 years; 70% men) who underwent elective TEVAR for chronic type B aortic dissection were enrolled in this single-center study. Nonobstructive general angioscopy was used before the stent graft procedure to observe the condition of the aortic intima and detect the presence of any irregular areas of erosion or plaque buildup from the aortic arch to the iliac artery. Angioscopic findings were used to determine stent graft position for TEVAR.
Angioscopy permitted to visualize the intima between a point just proximal to the descending aorta to the iliac artery in all patients. In all participants, an ulcer-like projection or entry point was identified at the proximal site. In addition, some patients had a small entry or tear (some with blood flowing from the site) in the intima, with a salmon-pink discoloration near the tear. Areas of a smooth white surface as well as smooth or irregular yellow plaques were also seen during the angioscopy. This contrasted with preoperative CT results, in which these angioscopic findings were not detected.
The position for the distal end of the stent graft was determined based on the position of the abnormal intima, with alterations in the surgical plan, if needed. The endoprosthesis was then deployed. The TEVAR procedure was successful in all cases. No angioscopy-related complications were reported in any patient.
Study limitations include its single-center setup, retrospective design, small sample size, sole reporting of preliminary results, and the fact that angioscopy is an invasive procedure.
“This modality may play an important role to determine the precise position of the stent graft during a TEVAR procedure as well as clarification of the mechanisms of aortic diseases,” noted the authors.
Nishi H, Higuchi Y, Takahashi T, et al. Aortic angioscopy assisted thoracic endovascular repair for chronic type B aortic dissection. J Cardiol. March 2020. doi:10.1016/j.jjcc.2020.02.011