ANGIOSCOPY, CORONARY THROMBI AND ACUTE CORONARY SYNDROMES

Coronary angioscopy is a new diagnostic imaging technique in which opt ic fibres are used to directly observe the intracoronary lumen. Angios copy provides a full colour, high resolution, three-dimensional image of the intracoronary artery surface morphology. Studies using angiosco py revealed that the frequency of coronary thrombi in patients with ac ute coronary syndromes was higher than previous studies, based on arte riography, had reported. Arteriographic recognition of thrombus in uns table angina was from 1.3% to 52%. On the other hand, thrombi were obs erved in 88% by angioscopy in patients with rest angina in our study. Whereas ordinary arteriography provides only two-dimensional black and white images, angioscopy can distinguish between a thrombus and a pla que, even if the clot is very small. In a study of 17 unstable angina and 22 myocardial infarction patients, the frequencies of coronary thr ombi in the two groups were essentially the same. Grayish-white thromb i were observed in most of the unstable angina patients but in none of the infarction patients. On the other hand, red or mixed red and whit e thrombi were observed in all infarction patients but in only a few u nstable angina patients. This difference may account for the contrasti ng results of thrombolytic therapy.