Attenuated Plaque at Nonculprit Lesions in Patients Enrolled in Intravascular Ultrasound Atherosclerosis Progression Trials

Bayturan, Özgür; Tuzcu, E. Murat; Nicholls, Stephen J.; Lavoie, Andrea; Uno, Kiyoko; Crowe, Tim; Magyar, William A.; Wolski, Kathy; Kapadia, Samir; Nissen, Steven E.; Schoenhagen, Paul

doi:10.1016/j.jcin.2009.05.007

Cited by 33 publications

(21 citation statements)

References 28 publications

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“…Three articles were further excluded due to no record of slow/no reflow phenomenon or clinical outcomes (13,15,21). Five observational studies, which described the association between attenuated plaques and incidence of slow/no reflow during PCI (11,14,16,22) and five studies that presented MACEs were included in the final meta analysis (Figure 2) (12,14,18,19,23).…”

Section: Search Resultsmentioning

confidence: 99%

“…Two studies involved ACS patients (13,14) and one study involved all CAD patients (11). Five other studies reported the MACEs (12,14,18,19,23). The sample size was 110 to 2,072 for these studies.…”

Section: Search Resultsmentioning

confidence: 99%

“…The sample size was 110 to 2,072 for these studies. Two studies involved ACS patients (14,18), two studies involved CAD patients (12,21) and one study involved patients with ST segment elevation myocardial infarction (STEMI) (23). The attenuated and non-attenuated plaque groups were comparable in age, gender and other demographic and baseline characteristics.…”

Section: Search Resultsmentioning

confidence: 99%

“…When they are found during coronary intervention, patients are more likely to experience induced coronary microembolism and slow/no reflow phenomenon (8). Several studies have reported that attenuated plaques impact on thrombolysis in myocardial infarction (TIMI) grade flow and portend an adverse prognosis (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19).…”

Section: Introductionmentioning

confidence: 99%

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Impact of attenuated plaques on TIMI grade flow and clinical outcomes of coronary artery disease patients: a systematic review and meta analysis

Nie¹,

Li²,

Zhu³

et al. 2016

J. Thorac. Dis.

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Background: Plaques with a large necrotic core or lipid pool and thin-cap fibroatheroma manifest as attenuated plaques on intravascular ultrasound (IVUS). Their impact on TIMI grade flow and clinical outcomes remains undefined. We performed a systematic review and meta-analysis to summarize the association between attenuated plaque and distal embolization and clinical outcomes of coronary artery disease (CAD) from pooled data of published eligible cohort studies. Methods:We searched the literature on TIMI grade flow and clinical outcomes on PubMed, Ovid, EMBASE, the Cochrane Library, CNKI and WanFang databases. Study heterogeneity and publication bias were estimated.Results: A total of 3,833 patients were enrolled in nine studies. Five studies investigated TIMI grade flow and attenuated plaques. They revealed no difference in TIMI grade flow before percutaneous coronary intervention (PCI) between the attenuated and non-attenuated plaque group (RR =1.25; 95% CI: 0.65 to 2.41; P=0.50).After balloon dilation and stent implantation, the incidence of TIMI 0~2 grade flow in the attenuated plaque group was statistically significant higher than that of the non-attenuated plaque group (RR =4.73; 95% CI: 3.03 to 7.40; P<0.001). Five other studies investigated major cardiovascular events (MACEs) and attenuated plaques and found no difference in MACE rates within three years of follow up.Conclusions: Our study presents the evidence that plaque with ultrasound signal attenuation would induce slow/no reflow phenomenon and distal embolization during PCI, but this appearance has no impact on MACE rates within three years.

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Section: Search Resultsmentioning

confidence: 99%

Section: Search Resultsmentioning

confidence: 99%

Section: Search Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of attenuated plaques on TIMI grade flow and clinical outcomes of coronary artery disease patients: a systematic review and meta analysis

Nie¹,

Li²,

Zhu³

et al. 2016

J. Thorac. Dis.

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“…Furthermore, noncalcified carotid plaques commonly exhibit a higher degree of fibrous cap inflammation, a key process in fibrous cap disruption. Calcification in ATS lesions is relatively common and has been implicated as a risk factor for increased cardiovascular morbidity and mortality (8,9), while Bayturan et al (10) and Hashimoto et al (11) demonstrated that carotid ATS plaque calcification is a structural marker for carotid plaque stability.…”

Section: Discussionmentioning

confidence: 99%

Assessment of vulnerable and unstable carotid atherosclerotic plaques on endarterectomy specimens

Butcovan¹,

Mocanu

Baran

et al. 2016

Experimental and Therapeutic Medicine

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Abstract. The types of lesion instability responsible for the majority of acute coronary events frequently include plaque disruption and plaque erosion with superimposed thrombosis. The term 'vulnerable plaque' is used to describe atherosclerotic (ATS) plaques that are particularly prone to rupture and susceptible to thrombus formation, such as the thin-cap fibroatheroma (TCFA). The aim of the present study was to assess the morphological and histological differences between plaques that are unstable and those that are vulnerable to instability. Carotid artery endarterectomy specimens were obtained from 26 patients with carotid artery stenosis, consisting of 20 men and 6 women (age range, 35-80 years). Histological and morphometric methods were used to visualize and characterize the ATS plaques. Among the 26 carotid ATS plaques, 23% were stable, 23% were unstable and 54% were vulnerable. With regard to morphometric characteristics, the following mean values were obtained for the TCFA and unstable plaques, respectively: Fibrous cap thickness, 21.91 and 11.66 µM; proportion of necrotic core area in the total plaque area, 25.90 and 22.03%; and the proportion of inflammatory area in the total plaque area, 8.41 and 3.04%. No plaque calcification was observed in any of them. Since ATS coronary artery disease is considerably widespread and fatal, it is crucial to further study ATS lesions to obtain an improved understanding of the nature of vulnerable and unstable plaques. The methods used to detect plaque size, necrotic core area and fibrous cap thickness are considered to be particularly useful for identifying vulnerable and unstable plaques.

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Emerging applications of nanotechnology for the diagnosis and management of vulnerable atherosclerotic plaques

Ortega

Reagan

et al. 2011

WIREs Nanomed Nanobiotechnol

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An estimated 16 million people in the United States have coronary artery disease (CAD), and approximately 325,000 people die annually from cardiac arrest. About two-thirds of unexpected cardiac deaths occur without prior recognition of cardiac disease. A vast majority of these deaths are attributable to the rupture of ‘Vulnerable atherosclerotic plaques’. Clinically, plaque vulnerability is typically assessed through imaging techniques, and ruptured plaques leading to acute myocardial infarction are treated through angioplasty or stenting. Despite significant advances, it is clear that current imaging methods are insufficiently capable for elucidating plaque composition—which is a key determinant of vulnerability. Further, the exciting improvement in the treatment of CAD afforded by stenting procedures has been buffered by significant undesirable host-implant effects, including restenosis and late thrombosis. Nanotechnology has led to some potential solutions to these problems by yielding constructs that interface with plaque cellular components at an unprecedented size scale. By leveraging the innate ability of macrophages to phagocytose nanoparticles, contrast agents can now be targeted to plaque inflammatory activity. Improvements in nano-patterning procedures have now led to increased ability to regenerate tissue isotropy directly on stents, enabling gradual regeneration of normal, physiologic vascular structures. Advancements in immunoassay technologies promise lower costs for biomarker measurements, and in the near future, may enable the addition of routine blood testing to the clinician’s toolbox—decreasing the costs of atherosclerosis-related medical care. These are merely three examples among many stories of how nanotechnology continues to promise advances in the diagnosis and treatment of vulnerable atherosclerotic plaques.

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Attenuated Plaque at Nonculprit Lesions in Patients Enrolled in Intravascular Ultrasound Atherosclerosis Progression Trials

Cited by 33 publications

References 28 publications

Impact of attenuated plaques on TIMI grade flow and clinical outcomes of coronary artery disease patients: a systematic review and meta analysis

Impact of attenuated plaques on TIMI grade flow and clinical outcomes of coronary artery disease patients: a systematic review and meta analysis

Assessment of vulnerable and unstable carotid atherosclerotic plaques on endarterectomy specimens

Emerging applications of nanotechnology for the diagnosis and management of vulnerable atherosclerotic plaques

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