This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Gonzalo, N. Articles by Serruys, P. W. Search for Related Content PubMed Articles by Gonzalo, N. Articles by Serruys, P. W. Related Collections Related Article

In Vivo Assessment of High-Risk Coronary Plaques at Bifurcations With Combined Intravascular Ultrasound and Optical Coherence Tomography

Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands

^_* Reprint requests and correspondence: Prof. Patrick W. Serruys, Thoraxcenter, Ba583a, Gravendijkwal 230, 3015 CE Rotterdam, the Netherlands (Email: p.w.j.c.serruys{at}erasmusmc.nl).

Objectives: This study sought to evaluate the in vivo frequency and distribution of high-risk plaques (i.e., necrotic core rich) at bifurcations using a combined plaque assessment with intravascular ultrasound–virtual histology (IVUS-VH) and optical coherence tomography (OCT).

Background: Pathological examinations have shown that atherosclerotic plaque rich in necrotic core is prone to develop at bifurcations. High-risk plaque detection could be improved by the combined use of a technique able to detect necrotic core (IVUS-VH) and a high-resolution technique that allows the measurement of the fibrous cap thickness (OCT).

Methods: From 30 patients imaged with IVUS-VH and OCT, 103 bifurcations were selected. The main branch was analyzed at the proximal rim of the ostium of the side branch, at the in-bifurcation segment and at the distal rim of the ostium of the side branch. Plaques with more than 10% confluent necrotic core by IVUS-VH were selected and classified as fibroatheroma (FA) or thin-cap fibroatheroma (TCFA) depending on the thickness of the fibrous cap by OCT (>65 or 65 µm for FA and TCFA, respectively).

Results: Twenty-seven FA (26.2%) and 18 TCFA (17.4%) were found out of the 103 lesions studied. Overall the percentage of necrotic core decreases from proximal to distal rim (16.8% vs. 13.5% respectively, p = 0.01), whereas the cap thickness showed an inverse tendency (130 ± 105 µm vs. 151 ± 68 µm for proximal and distal rim, respectively, p = 0.05). The thin caps were more often located in the proximal rim (15 of 34, 44.1%), followed by the in-bifurcation segment (14 of 34, 41.2%), and were less frequent in the distal rim (5 of 34, 14.7%).

Conclusions: The proximal rim of the ostium of the side branch has been identified as a region more likely to contain thin fibrous cap and a greater proportion of necrotic core.

Key Words: high-risk coronary plaques • optical coherence tomography • IVUS virtual histology • bifurcation

Abbreviations and Acronyms   ACS = acute coronary syndrome   AIT = adaptative intimal thickening   CaFA = calcified fibroatheroma   CaTCFA = calcified thin-cap fibroatheroma   FA = fibroatheroma   IVUS-VH = intravascular ultrasound–virtual histology   LAD = left anterior descending artery   LCX = left circumflex artery   MMP = matrix metalloproteinase   NC = necrotic core   OCT = optical coherence tomography   PIT = pathological intimal thickening   RCA = right coronary artery   TCFA = thin-cap fibroatheroma

Related Article

The Vulnerable Plaque "Hypothesis": Promise, but Little Progress

Steven E. Nissen
J. Am. Coll. Cardiol. Img. 2009 2: 483-485. [Full Text] [PDF]

This article has been cited by other articles:

				H. M Garcia-Garcia, N. Gonzalo, E. Regar, and P. W Serruys Virtual histology and optical coherence tomography: from research to a broad clinical application Heart, August 15, 2009; 95(16): 1362 - 1374. [Full Text] [PDF]

				S. E. Nissen The Vulnerable Plaque "Hypothesis": Promise, but Little Progress J. Am. Coll. Cardiol. Img., April 1, 2009; 2(4): 483 - 485. [Full Text] [PDF]