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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

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