Analysis of Plaque Composition in Coronary Chronic Total Occlusion Lesion Using Virtual Histology-Intravascular Ultrasound

Abstract

Background and ObjectivesSuccess rates of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) have recently been reported to range from 80% to 90%. A better understanding of the pathologic characteristics of the CTO lesion may helpful to improving CTO PCI success rates. We evaluated the CTO lesion in patients with stable angina (SA) by virtual histology-intravascular ultrasound (VH-IVUS).Subjects and MethodsThe study population consisted of 149 consecutive patients with SA underwent VH-IVUS examination. We analyzed demographic and VH-IVUS findings in 22 CTO patients (17 males; mean, 62.3 years old) compared with 127 non-CTO patients (82 males; mean, 61.3 years old).ResultsA significantly lower ejection fraction (57.6±13.0% vs. 65.4±8.8%, p=0.007) was detected in the CTO group compared with the non-CTO group. Reference vessel lumen area of the proximal and distal segment was significantly less in CTO group than in non-CTO group. The lesion length of the CTO group was significantly longer than those of the non-CTO group (24.4±9.6 mm vs. 17.2±7.4 mm, p<0.001). Total atheroma volume (224±159 mm3 vs. 143±86 mm3, p=0.006) and percent atheroma volume (63.2±9.6% vs. 55.8±8.5%, p=0.011) of the CTO group were also significantly greater than those of non-CTO group. However, the lesion length adjusted plaque composition of the CTO group was not significantly different compared with that of the non-CTO group.ConclusionCTO lesions had a longer lesion length and greater plaque burden than the non-CTO lesion in patients with SA. However, lesion length adjusted plaque composition showed similar between the two groups. These results support that plaque characteristics of CTO lesions are similar to non-CTO lesions in patients with SA.

Evolution of nonculprit coronary atherosclerotic plaques assessed by serial virtual histology intravascular ultrasound in patients with ST-segment elevation myocardial infarction and chronic total occlusion

“…The analysis and comparison of the nonculprit plaques of two distinct diagnoses, that is, STEMI and CTO, may provide a better understanding of the plaques. Especially nonculprit proximal plaques of CTO lesions showed a similar plaque composition to the CTO lesion 5, which was a distinct characteristic compared with that of stable nonocclusive coronary diseases 6.…”

A Novel Classification for Predicting Chronic Total Occlusion Percutaneous Coronary Intervention

“…Except for proximal and distal fibrous caps, the occluded segment materials were biologically active with inflammation, neovascularization, and recanalization, giving rise to different CTO compositions. Similar to non-CTO lesions in patients with stable angina, the composition of CTO lesions mainly consists of three types, namely, necrotic core, fibrous, and dense calcium ( 17 ). Previous studies exploring GW crossing predictors always focus on the severity of calcification in terms of plaque characteristics, which revealed that calcification is likely to be a predictive factor of failed GW crossing within 30 min.…”

Current approaches for treatment of coronary chronic occlusions

“…The body frequently contains some degree of neovascularization, dense fibrous tissue, atheroma, calcified tissue, and focal lymphocyte infiltrate [31]. This type of lesions could involve a long coronary segment with a large plaque burden [32]. A study conducted by Guo et al using intravascular ultrasounds virtual histology (IVUS-VH) to evaluate CTO lesion characteristics, revealed the presence of two relatively different CTO plaque types: one presenting a large amount of necrotic core, possibly deriving from ruptured plaques associated with previous acute coronary syndromes, and the other one characterized by a little or absent necrotic core, compatible with slowly evolving plaques.…”