[Frequency of acute plaque ruptures and thin cap atheromas at sites of maximal stenosis].

BACKGROUND There have been few autopsy studies relating sites of thin cap atheroma (TCFA) to sites of acute plaque rupture in culprit arteries, and sites of maximal narrowing in non-culprit arteries. OBJECTIVE We aimed to quantify and locate the frequency of TCFA related to the sites of maximal stenosis in atherosclerotic plaques. METHODS We studied 88 hearts in victims of sudden death dying with coronary thrombus overlying acute plaque rupture. Thin cap atheromas were defined as fibrous cap < 65 microns overlying a necrotic core. Percent luminal narrowing was determined at the sites of plaque rupture and thin cap atheromas. RESULTS There were 81 men and 7 women, mean age 50 years +/- 9 SD. The plaque rupture was the site of maximal luminal narrowing in 47% of culprit arteries. TCFAs were present in 67 hearts (83%). Of these, 49 (73%) demonstrated TCFAs in the culprit artery; 17 (25%) in the culprit artery only, 32 (48%) in the culprit artery and in a non-culprit artery, and 18 (27%) only in a non-culprit artery. In non-culprit arteries, TCFAs represented the maximal site of stenosis in 44% of arteries. The acute rupture site is the site of maximal luminal narrowing in the involved vessel in 47% of hearts from patients dying with acute plaque rupture. CONCLUSION These data may suggest that luminal narrowing is not a reliable marker for TCFA.

[1]  S. Achenbach,et al.  Detecting vulnerable plaque of arteriosclerosis obliterans by multidetector-row computed tomography--comparing with VH (virtual histology)-intravascular ultrasound. , 2008, International journal of cardiology.

[2]  V. Fuster,et al.  Coronary plaque disruption. , 1995, Circulation.

[3]  E. Tuzcu,et al.  Coronary Plaque Classification With Intravascular Ultrasound Radiofrequency Data Analysis , 2002, Circulation.

[4]  Jeroen J. Bax,et al.  Characterisation of the "vulnerable" coronary plaque by multi-detector computed tomography: a correlative study with intravascular ultrasound-derived radiofrequency analysis of plaque composition. , 2008, EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology.

[5]  R. Virmani,et al.  34th Bethesda Conference: Task force #2--What is the pathologic basis for new atherosclerosis imaging techniques? , 2003, Journal of the American College of Cardiology.

[6]  Jeroen J. Bax,et al.  Evaluation of plaque characteristics in acute coronary syndromes: non-invasive assessment with multi-slice computed tomography and invasive evaluation with intravascular ultrasound radiofrequency data analysis. , 2008, European heart journal.

[7]  J. Muller,et al.  Near-infrared spectroscopy for the detection of vulnerable coronary artery plaques. , 2006, Journal of the American College of Cardiology.

[8]  Filippo Cademartiri,et al.  Imaging techniques for the vulnerable coronary plaque , 2007, La radiologia medica.

[9]  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.

[10]  S. Momomura,et al.  Plaque Characteristics of the Coronary Segment Proximal to the Culprit Lesion in Stable and Unstable Patients , 2009, Clinical cardiology.

[11]  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.

[12]  H. Saji,et al.  A catheter-based intravascular radiation detector of vulnerable plaques. , 2006, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[13]  M. Fishbein,et al.  The vulnerable and unstable atherosclerotic plaque. , 2010, Cardiovascular pathology : the official journal of the Society for Cardiovascular Pathology.

[14]  P. Moreno,et al.  Detection of Lipid Pool, Thin Fibrous Cap, and Inflammatory Cells in Human Aortic Atherosclerotic Plaques by Near-Infrared Spectroscopy , 2002, Circulation.

[15]  Renu Virmani,et al.  Pathology of the thin-cap fibroatheroma: a type of vulnerable plaque. , 2003, Journal of interventional cardiology.

[16]  K. Toutouzas,et al.  Imaging of the vulnerable plaque: noninvasive and invasive techniques. , 2008, The American journal of the medical sciences.

[17]  T. Akasaka,et al.  Recent advances in intracoronary imaging techniques: focus on optical coherence tomography , 2008, Expert review of medical devices.

[18]  R. Virmani,et al.  Pathology of the Vulnerable Plaque , 2006 .

[19]  R. Virmani,et al.  Differential Accumulation of Proteoglycans and Hyaluronan in Culprit Lesions: Insights Into Plaque Erosion , 2002, Arteriosclerosis, thrombosis, and vascular biology.

[20]  R. Virmani,et al.  Plaque Rupture and Plaque Erosion , 1999, Thrombosis and Haemostasis.

[21]  R. Virmani,et al.  Pathology of the unstable plaque. , 2002, Progress in cardiovascular diseases.

[22]  D. Faxon,et al.  Five-year angiographic follow-up of factors associated with progression of coronary artery disease in the Coronary Artery Surgery Study (CASS). CASS Participating Investigators and Staff. , 1993, Journal of the American College of Cardiology.

[23]  J. Ambrose.  In search of the "vulnerable plaque": can it be localized and will focal regional therapy ever be an option for cardiac prevention? , 2008, Journal of the American College of Cardiology.

[24]  E. Boerwinkle,et al.  From vulnerable plaque to vulnerable patient: a call for new definitions and risk assessment strategies: Part I. , 2003, Circulation.

[25]  J. Muller,et al.  Atheromatous plaque cap thickness can be determined by quantitative color analysis during angioscopy: Implications for identifying the vulnerable plaque , 2004, Clinical cardiology.

[26]  W N McDicken,et al.  In vitro analysis of coronary atheromatous lesions by intravascular ultrasound; reproducibility and histological correlation of lesion morphology. , 1999, European heart journal.

[27]  R. Virmani,et al.  The thin-cap fibroatheroma: a type of vulnerable plaque: The major precursor lesion to acute coronary syndromes , 2001, Current opinion in cardiology.

[28]  R. Virmani,et al.  Frequency and distribution of thin-cap fibroatheroma and ruptured plaques in human coronary arteries: a pathologic study. , 2007, Journal of the American College of Cardiology.

[29]  Hiroyuki Okura,et al.  Frequency and spatial distribution of thin-cap fibroatheroma assessed by 3-vessel intravascular ultrasound and optical coherence tomography: an ex vivo validation and an initial in vivo feasibility study. , 2009, Circulation journal : official journal of the Japanese Circulation Society.