Characterization of coronary plaques with combined use of intravascular ultrasound, virtual histology and optical coherence tomography
Abstract
Overview
According to post-mortem studies, luminal
thrombosis occurs from plaque rupture, erosion
and calcified nodules. In vivo studies
have found thin cap fibroatheroma (TCFA) as
the main vulnerable lesion, prone to rupture.
Few data about other post-mortem lesions
have been reported in vivo. Our main objective
is to characterize in vivo the coronary
plaques with intravascular ultrasound-virtual histology (IVUS-VH) and optical coherence
tomography (OCT), in order to detect not only
thin cap fibroatheroma (TCFA), but also other
possible vulnerable lesions. The secondary
objective is to correlate these findings with
clinical and analytical data. Twenty-five
patients (18 stable) submitted to coronary
angiography were included in this pilot study.
After angiography, the three vessels were
studied (when possible) with IVUS-VH and
OCT. Plaque characteristics were correlated
with clinical and analytical data. Forty-six
lesions were analyzed. IVUS-VH detected significant
necrotic core in 15 (3 were definite
TCFA). OCT detected TCFA in 10 lesions, erosion
in 6, thrombus in 5 and calcified nodule
in 8. Possible vulnerable lesion was found in
61% of stable and 57% of unstable patients.
Erosions and calcified nodules were only
found in stable patients. Those with significant
necrotic core had higher body mass index
(P=0.016), higher levels of hs-CRP (P=0.019)
and triglycerides (P=0.040). The higher the
levels of hs-CRP, the larger the size of the
necrotic core (r=0.69, P=0.003). Lesions with
characteristics of vulnerability were detected
by IVUS-VH and OCT in more than 50% of stable
and unstable coronary patients. A significant
necrotic core was mainly correlated with
higher hs-CRP.
Keywords
Vulnerable plaque, thin cap fibro – atheroma, necrotic core.
Article Information
Correspondence
José Calabuig, Dept. Cardiology, ClÃnica Universidad de Navarra, Avda Pio Doce 36, 31008 Pamplona, Spain. E-mail: jcalabuig@unav.es
Acknowledgements
We gratefully acknowledge the
help of the Cath Lab nurses. Thanks to their
unconditional support we have been able to carry
out this research.
This work was partially supported by a grant from:
Departamento de Salud. Gobierno de Navarra
(ref 15/2008) and PIUNA, Universidad de
Navarra.
Received
2010-06-24T00:00:00
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