OCT Assessment of Thin-Cap Fibroatheroma Distribution in Native Coronary Arteries
Kenichi Fujii, MD*,*,
Daizo Kawasaki, MD*,
Motomaru Masutani, MD ,
Takahiro Okumura, MD,
Takafumi Akagami, MD,
Tsuyoshi Sakoda, MD,
Takeshi Tsujino, MD*,
Mitsumasa Ohyanagi, MD,
Tohru Masuyama, MD*
* Cardiovascular Division, Hyogo College of Medicine, Nishinomiya, Japan
Division of Coronary Heart Disease, Hyogo College of Medicine, Nishinomiya, Japan
* Reprint requests and correspondence: Dr. Kenichi Fujii, Hyogo College of Medicine, Cardiovascular Division, 1-1 Mukogawa-cho, Nishinomiya-city, Hyogo 6638501, Japan (Email: kfujii{at}hyo-med.ac.jp).
Objectives: We evaluated the geographic distribution of thin-cap fibroatheromas (TCFAs) in the coronary arteries using optical coherence tomography (OCT), a high-resolution imaging modality.
Background: Plaque rupture is the most frequent cause of acute myocardial infarction (AMI). It has been recognized that TCFA is the primary plaque type at the site of plaque rupture.
Methods: We performed 3-vessel OCT examinations in 55 patients: 35 AMI and 20 stable angina pectoris patients. The criteria for TCFA in an OCT image was a lipid-rich plaque with fibrotic cap thickness <65 µm. The distance between each TCFA location and the respective coronary artery ostium was measured with motorized OCT imaging pullback. The total length of all 3 coronary arteries imaged by OCT pullbacks was 82 ± 21 mm in the left anterior descending coronary artery (LAD), 67 ± 26 mm in the left circumflex coronary artery (LCx), and 104 ± 32 mm in the right coronary artery (RCA).
Results: OCT detected 94 TCFAs in 165 coronary arteries. The minimum fibrous-cap thickness of TCFAs was 57.4 ± 5.4 µm in AMI patients, and 55.9 ± 7.3 µm in stable angina pectoris patients (p = 0.4). Of the total of 94 TCFAs, 28 were detected in the LAD, 18 in the LCx, and 48 in the RCA. Most LAD TCFAs were located between 0 and 30 mm from the LAD ostium (76%). Conversely, LCx and RCA TCFAs were evenly distributed throughout the entire coronary length. The clustering of the TCFAs was similar in culprit segments as compared with nonculprit segments. In AMI patients, most LAD TCFAs were distributed near side branches, mainly positioned opposite the side branch bifurcation.
Conclusions: Three-vessel OCT imaging showed that TCFAs tend to cluster in predictable spots within the proximal segment of the LAD, but develop relatively evenly in the LCx and RCA arteries.
Key Words: optical coherence tomography • vulnerable plaque • acute coronary syndrome
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Abbreviations and Acronyms
| | AMI = acute myocardial infarction | | IVUS = intravascular ultrasound | | LAD = left anterior descending coronary artery | | LCx = left circumflex coronary artery | | OCT = optical coherence tomography | | RCA = right coronary artery | | SAP = stable angina pectoris | | TCFA = thin-cap fibroatheroma |
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Writing Committee Members, G. N. Levine, E. R. Bates, J. C. Blankenship, S. R. Bailey, J. A. Bittl, B. Cercek, C. E. Chambers, S. G. Ellis, R. A. Guyton, et al.
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Circulation,
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124(23):
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