ANGIOSCOPIC VERSUS ANGIOGRAPHIC DETECTION OF INTIMAL DISSECTION AND INTRACORONARY THROMBUS

Objectives. This study was undertaken to compare coronary angioscopy w ith angiography for the detection of intimal dissection and intracoron ary thrombus. Background. It has been demonstrated previously that cor onary angioscopy provides more intravascular detail than cineangiograp hy. Both imaging methods have to be compared directly to assess the ad ditional diagnostic value of angioscopy. Methods. The angiograms and v ideotapes of 52 patients who had undergone angioscopy, were reviewed i ndependently by two observers unaware of other findings. Classic angio graphic definitions were used for dissection and thrombus. Angioscopic dissection was defined as visible cracks or fissures on the lumen sur face or mobile protruding structures that are contiguous with the vess el wall. Angioscopic thrombus was defined as a red, white or mixed red and white intraluminal mass. Results. Angiography and angioscopy were in agreement in 40.4% of cases in the absence of thrombus and in 11.5 % in the presence of thrombus. No fewer than 25 (48.1%) angioscopicall y observed thrombi remained undetected at angiography. With angioscopy as the standard, although the specificity of angiography for thrombus was 100%, sensitivity was very low at 19%. Angioscopic dissection was present in 40 patients (76.9%) versus angiographic dissection in 15 p atients (28.8%). With regard to dissection, there was no correlation b etween the two imaging methods (r(phi) = 0.15, p = 0.29). Conclusions. Coronary angiography underestimates the presence of intracoronary thr ombus. Angioscopy and angiography are complementary techniques for det ecting and grading intimal dissections.