Necrotic core and thin cap fibrous atheroma distribution in native coronary artery lesion-containing segments: A virtual histology intravascular ultrasound study

Shmuel Fuchs, Ifat Lavi, Omer Tzang, Shir Fuchs, David Brosh, Tamir Bental, Danny Dvir, Shmuel Einav, Ran Kornowski

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: The aim of this study was to assess the longitudinal topographical relationships between minimal luminal area (MLA) sites and plaques with the most vulnerable characteristics using radiofrequency-based virtual histology intravascular ultrasound analysis. Methods: We analyzed 69 native coronary artery segments with de-novo lesions (>50% stenosis) obtained from 50 patients with ischemic coronary artery disease. Maximal necrotic core (maxNC) was defined as a virtual histology intravascular ultrasound frame with the maxNC area and virtual histology-characterized thin cap fibrous atheroma was defined as a cross-section, which contained a plaque burden of more than 40%, relative necrotic core area of 10% or more, and a narrow band encircling the lumen containing relative necrotic core area of more than 10%, in three consecutive frames. Results: MaxNC was present at the MLA site in only 17.4% of the segments, proximal in 52.2% (by 5.0±5.4 mm), and distal to MLA in 30.4% (by 4.0±5.1 mm). Non-MLA sites with maxNC (n=57) compared with MLA sites had reduced plaque burden (64.5±11.2% vs. 76.0±10.5%, P<0.001), increased remodeling index (1.04±0.17 vs. 0.89±0.15, P<0.001), less fibrotic tissue (47.7±13.4% vs. 54.8±13.8%, P<0.001), and higher dense calcium deposition (15.3±10.8% vs. 11.9±10.3%, P<0.001). Plaques containing maxNC and virtual histology-characterized thin cap fibrous atheroma were found in 23 of the non-MLA sites compared with two of the MLA sites (P<0.0001). Conclusions: In coronary artery segments with intermediate-to-severe stenosis, plaques containing maxNC are mostly located away from the MLA site and more often comprise virtual histology-characterized thin cap fibrous atheroma. Such data may carry practical implications for coronary revascularization procedures.

Original languageEnglish
Pages (from-to)339-344
Number of pages6
JournalCoronary Artery Disease
Volume22
Issue number5
DOIs
StatePublished - Aug 2011

Keywords

  • atherosclerosis
  • intravascular ultrasound
  • necrotic core
  • thin cap fibrous atheroma
  • virtual histology
  • vulnerable plaque

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