Thin-cap fibroatheroma and microchannel findings in optical coherence tomography correlate with subsequent progression of coronary atheromatous plaques.

AIMS Morphological characteristics of non-significant coronary plaques (NSCPs) that develop rapid progression have not been fully elucidated. The aim of this study was to clarify the morphological characteristics of NSCPs in patients with coronary artery disease (CAD) using intravascular optical coherence tomography (OCT). METHODS AND RESULTS Fifty-three consecutive CAD patients undergoing percutaneous coronary intervention were enrolled and 69 NSCPs (per cent diameter stenosis <50%) were identified on baseline angiogram. Baseline characteristics of NSCPs were evaluated by OCT, and patients were followed-up prospectively. At the second coronary angiography, the baseline OCT characteristics and plaque progression were correlated. During the 7-month follow-up period, 13 NSCPs showed angiographic progression and 56 NSCPs did not. Baseline minimum lumen diameter and diametric stenosis were similar between NSCPs with and without progression. Compared with NSCPs without progression, those with progression showed a significantly higher incidence of intimal laceration (61.5 vs. 8.9%, P < 0.01), microchannel (76.9 vs. 14.3%, P < 0.01), lipid pools (100 vs. 60.7%, P = 0.02), thin-cap fibroatheroma (TCFA) (76.9 vs. 14.3%, P < 0.01), macrophage images (61.5 vs. 14.3%, P < 0.01), and intraluminal thrombi (30.8 vs. 1.8%, P < 0.01). Univariate regression analysis showed that TCFA and microchannel images showed high correlation with subsequent luminal progression [odds ratio (OR): 20.0, P < 0.01 and OR: 20.0, P < 0.01, respectively]. CONCLUSION Optical coherence tomography-based complex characteristics of TCFA and microchannel were the potential predictors of subsequent progression of NSCPs in patients with CAD.

[1]  E. Halpern,et al.  Quantification of Macrophage Content in Atherosclerotic Plaques by Optical Coherence Tomography , 2003, Circulation.

[2]  D. Waters,et al.  Advantages and limitations of serial coronary arteriography for the assessment of progression and regression of coronary atherosclerosis. Implications for clinical trials. , 1993, Circulation.

[3]  Gary S. Mintz,et al.  The dynamic nature of coronary artery lesion morphology assessed by serial virtual histology intravascular ultrasound tissue characterization. , 2010, Journal of the American College of Cardiology.

[4]  R. Virmani,et al.  Lessons from sudden coronary death: a comprehensive morphological classification scheme for atherosclerotic lesions. , 2000, Arteriosclerosis, thrombosis, and vascular biology.

[5]  Colin Berry,et al.  Comparison of Intravascular Ultrasound and Quantitative Coronary Angiography for the Assessment of Coronary Artery Disease Progression , 2007, Circulation.

[6]  W. Santamore,et al.  Can coronary angiography predict the site of a subsequent myocardial infarction in patients with mild-to-moderate coronary artery disease? , 1988, Circulation.

[7]  G. Finet,et al.  Evolution of Spontaneous Atherosclerotic Plaque Rupture With Medical Therapy: Long-Term Follow-Up With Intravascular Ultrasound , 2004, Circulation.

[8]  R. Virmani,et al.  Coronary plaque erosion without rupture into a lipid core. A frequent cause of coronary thrombosis in sudden coronary death. , 1996, Circulation.

[9]  Takashi Akasaka,et al.  The effect of lipid and inflammatory profiles on the morphological changes of lipid-rich plaques in patients with non-ST-segment elevated acute coronary syndrome: follow-up study by optical coherence tomography and intravascular ultrasound. , 2010, JACC. Cardiovascular interventions.

[10]  T Akasaka,et al.  Cardiac optical coherence tomography , 2008, Heart.

[11]  Stephen J. Nicholls,et al.  Intravascular ultrasound-derived measures of coronary atherosclerotic plaque burden and clinical outcome. , 2010, Journal of the American College of Cardiology.

[12]  K. Seung,et al.  Visualization of coronary atherosclerotic plaques in patients using optical coherence tomography: comparison with intravascular ultrasound. , 2002, Journal of the American College of Cardiology.

[13]  Hiroto Tsujioka,et al.  Relation of microchannel structure identified by optical coherence tomography to plaque vulnerability in patients with coronary artery disease. , 2010, The American journal of cardiology.

[14]  R. Virmani,et al.  Small black holes in optical frequency domain imaging matches intravascular neoangiogenesis formation in histology. , 2010, European heart journal.

[15]  E. Halpern,et al.  Characterization of Human Atherosclerosis by Optical Coherence Tomography , 2002, Circulation.

[16]  Eiji Toyota,et al.  Assessment of coronary arterial plaque by optical coherence tomography. , 2006, The American journal of cardiology.

[17]  Brett E Bouma,et al.  Relationship Between a Systemic Inflammatory Marker, Plaque Inflammation, and Plaque Characteristics Determined by Intravascular Optical Coherence Tomography , 2007, Arteriosclerosis, thrombosis, and vascular biology.

[18]  Renu Virmani,et al.  Thin-walled microvessels in human coronary atherosclerotic plaques show incomplete endothelial junctions relevance of compromised structural integrity for intraplaque microvascular leakage. , 2009, Journal of the American College of Cardiology.

[19]  Marco Valgimigli,et al.  In vivo intravascular ultrasound-derived thin-cap fibroatheroma detection using ultrasound radiofrequency data analysis. , 2005, Journal of the American College of Cardiology.

[20]  R. Virmani,et al.  Concept of vulnerable/unstable plaque. , 2010, Arteriosclerosis, thrombosis, and vascular biology.

[21]  Nicusor Iftimia,et al.  Focal and multi-focal plaque macrophage distributions in patients with acute and stable presentations of coronary artery disease. , 2004, Journal of the American College of Cardiology.

[22]  B Meier,et al.  Relation of the site of acute myocardial infarction to the most severe coronary arterial stenosis at prior angiography. , 1992, The American journal of cardiology.

[23]  L. Wilkins.  Early Effects of Tissue‐Type Plasminogen Activator Added to Conventional Therapy on the Culprit Coronary Lesion in Patients Presenting With Ischemic Cardiac Pain at Rest Results of the Thrombolysis in Myocardial Ischemia (TIMI IIIA) Trialx , 1993, Circulation.

[24]  M. Takano,et al.  CLINICAL RESEARCH Coronary Artery Disease Angioscopic Follow-Up Study of Coronary Ruptured Plaques in Nonculprit Lesions , 2005 .

[25]  Takashi Akasaka,et al.  Assessment of culprit lesion morphology in acute myocardial infarction: ability of optical coherence tomography compared with intravascular ultrasound and coronary angioscopy. , 2007, Journal of the American College of Cardiology.

[26]  G. Ripandelli,et al.  Optical coherence tomography. , 1998, Seminars in ophthalmology.

[27]  R. Virmani,et al.  Coronary risk factors and plaque morphology in men with coronary disease who died suddenly. , 1997, The New England journal of medicine.

[28]  Brett E Bouma,et al.  Diagnostic accuracy of optical coherence tomography and integrated backscatter intravascular ultrasound images for tissue characterization of human coronary plaques. , 2006, Journal of the American College of Cardiology.

[29]  Konstantin Nikolaou,et al.  Accuracy of multidetector spiral computed tomography in identifying and differentiating the composition of coronary atherosclerotic plaques: a comparative study with intracoronary ultrasound. , 2004, Journal of the American College of Cardiology.

[30]  J. G. Fujimoto,et al.  Assessing atherosclerotic plaque morphology: comparison of optical coherence tomography and high frequency intravascular ultrasound. , 1997, Heart.