Diagnosis of Carotid Artery Plaque Using Angioscopy

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With advances in medical engineering, endoscopy using an optical fiber has become thin with high-image quality and high resolution, and it is used as angioscopy in the vascular disease. Angioscopy has been used in the coronary artery disease since the 1980s and contributed to the clarification of the pathology of coronary artery disease, but fewer studies have been reported in the carotid artery disease. Angioscopy is covered by national health insurance for the coronary artery disease, but it is not covered in the carotid artery disease. After approval by the Ethics Committee and obtaining consent from patients, I diagnose plaque by angioscopy before and after placing a stent in carotid artery stenting (CAS) and observe the blood vessel after stenting, for which safe application of angioscopy is necessary. Using the modified Parodi method + distal filter protection, blood is removed by flashing heparinized saline through a parent catheter and the vascular lumen is observed. When the plaque was examined before placing a stent, the plaque was whitish and indistinguishable from the normal blood vessel in patients treated with CAS in the subacute and chronic phases, but intimal hyperplasia and hemorrhage were noted in plaque in only one patient treated with CAS in the acute phase. Accumulation of acute phase cases may be important to elucidate the pathology of carotid artery plaque on angioscopy.