The use of coronary angioscopy in diagnosis and clinical decision making

Although coronary angioscopy, shortly after its introduction in 1991, seemed promising as a clinical decision tool in interventional cardiology, it has until now mainly been used as a device for clinical research. It is somewhat surprising that this imaging modality proved to be in lack of practical applications. Nevertheless, angioscopy can reliably discriminate unstable from stable lesions, and be of value in the management of threatened acute closure after PTCA or stenting. Its sensitivity and specificity in the detection of intracoronary thrombus is unsurpassed. A new class of drugs, the glycoprotein Ilb/IIIa inhibitors, is presently making a large impact on interventional cardiology. Coronary angioscopy can potentially play an important role in research as well as clinical use of such drugs, because it is essentially the only reliable tool for intracoronary thrombus detection.