Author + information
- Received November 14, 2010
- Revision received March 2, 2011
- Accepted March 10, 2011
- Published online June 1, 2011.
- Yoshinori Miyamoto, MD⁎ (, )
- Hiroyuki Okura, MD,
- Teruyoshi Kume, MD,
- Takahiro Kawamoto, MD,
- Yoji Neishi, MD,
- Akihiro Hayashida, MD,
- Ryotaro Yamada, MD,
- Koichiro Imai, MD,
- Ken Saito, MD and
- Kiyoshi Yoshida, MD
- ↵⁎Reprint requests and correspondence:
Dr. Hiroyuki Okura, Kawasaki Medical School, 577 Matsushima, Kurashiki 701-0192, Japan
Objectives The purpose of this study was to assess plaque characteristics of optical coherence tomography (OCT)-derived thin-cap fibroatheroma (TCFA) by integrated backscatter intravascular ultrasound (IB-IVUS).
Background Radiofrequency signal-derived IVUS tissue characterization technology has become clinically available and provided objective and quantitative plaque characteristics of the coronary vessel wall. Integrated backscatter IVUS is one of the tissue characterization methods that can possibly provide quantitative plaque characteristics of the OCT-derived TCFA.
Methods Eighty-one coronary lesions with plaque burden >40% were selected and analyzed with both IB-IVUS and OCT. The OCT-derived TCFA was defined as a presence of thin fibrous cap (<65 μm) overlying a signal-poor lesion with diffuse border representing a lipid-rich plaque. By conventional gray-scale IVUS, external elastic membrane (EEM) cross-sectional area (CSA), lumen CSA, plaque plus media (P+M) CSA, plaque burden and remodeling index were measured. By IB-IVUS, plaque characteristics were further classified as fibrosis, dense fibrosis, calcification, or lipid pool.
Results Optical coherence tomography identified 40 TCFAs (49%) and 41 non-TCFAs. The EEM CSA, P+M CSA, plaque burden, and remodeling index were significantly larger in OCT-derived TCFA than non-TCFA. By IB-IVUS, percentage lipid pool area (= lipid pool area/P+M CSA × 100) was significantly higher (62.4 ± 12.8% vs. 38.4 ± 13.1%, p < 0.0001) and percentage fibrosis area (= fibrosis area/P+M CSA × 100) was significantly lower (34.6 ± 11.4% vs. 50.5 ± 8.7%, p < 0.0001) in OCT-derived TCFA than non-TCFA. By receiver-operator characteristic curve analysis, percentage lipid pool area ≥55%, percentage fibrosis area ≤41%, and remodeling index ≥1.0 were predictors of OCT-derived TCFA.
Conclusions The OCT-derived TCFA had larger plaque burden and positive remodeling with predominant lipid component and less fibrous plaque assessed by IB-IVUS.
This research was partially supported by the Japanese Ministry of Education, Culture, Sports, Science and Technology, Grant-in-Aid for Scientific Research (No. 20590849). All authors have reported that they have no relationships to disclose.
- Received November 14, 2010.
- Revision received March 2, 2011.
- Accepted March 10, 2011.
- American College of Cardiology Foundation