Frequency and Distribution of Thin-Cap Fibroatheroma and Ruptured Plaques in Human Coronary Arteries

Cheruvu, Pavan K.; Finn, Aloke V.; Gardner, Craig; Caplan, Jay D.; Goldstein, James A.; Stone, Gregg W.; Virmani, Renu; Muller, James E.

doi:10.1016/j.jacc.2007.04.086

Cited by 325 publications

(202 citation statements)

References 49 publications

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“…W badaniach angiograficznych potwierdzono te obserwacje. Ponadto wykazały one, że u nawet 40% pacjentów z NSTEMI-ACS z nasiloną CAD można zaobserwować liczne złożone blaszki spełniające kryteria zmian odpowiedzialnych za niedokrwienie [306,308,312,313]. Prawie 1/4 pacjentów z NSTEMI ma na ostro zamkniętą tętnicę wieńcową, a 2/3 zamkniętych tętnic ma już wykształcone krążenie oboczne w momencie wykonywania koronarografii [223,310].…”

Section: Identyfikacja Zmiany Odpowiedzialnej Za Niedokrwienieunclassified

2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation

Roffi¹,

Patrono²,

Collet³

et al. 2015

Kardiol Pol

207

165

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Section: Identyfikacja Zmiany Odpowiedzialnej Za Niedokrwienieunclassified

2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation

Roffi¹,

Patrono²,

Collet³

et al. 2015

Kardiol Pol

207

165

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“…20 These findings are supported by the results of pathological studies showing that in human coronary arteries vulnerable plaque, characterized by a lipid core with a thin fibrous cap, and ruptured plaque are most prevalent in the proximal coronary tree. 21,22 The role of systemic factors such as inflammation 6 and lowdensity lipoprotein cholesterol 7 in the development of plaque vulnerability has been well documented. Recent interest has focused on the role of local factors, such as shear stress, in the development of high-risk coronary sites 5,23 and the genesis and progression of coronary atherosclerotic lesions.…”

Section: Discussionmentioning

confidence: 99%

Plaque Location in the Left Anterior Descending Coronary Artery and Tissue Characteristics in Angina Pectoris: An Integrated Backscatter Intravascular Ultrasound Study

Komura

Hibi

Kusama

et al. 2010

Circ J

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Background: Ruptured plaque and culprit lesions associated with anterior acute myocardial infarction cluster mainly in the proximal segment of the left anterior descending coronary artery (LAD). This study investigated whether the tissue characteristics of plaque in the proximal LAD differs from that of plaque in the distal LAD as assessed by integrated backscatter (IB)-intravascular ultrasound (IVUS). Methods and Results:IVUS interrogation was used to study 107 non-culprit intermediate plaques in 68 patients with angina pectoris who underwent percutaneous coronary interventions. Proximal and distal segments were defined as <30 mm and ≥30 mm from the ostium, respectively. IB-IVUS images were recorded, and the average percentage values of each plaque component (lipid, fibrosis, dense fibrosis, and calcification) were compared between segments. Plaques in the proximal segment (n=51) had a higher %lipid content (36 vs 19%, P<0.01) and a lower %fibrosis content (57 vs 64%, P<0.01) than did plaques in the distal segment (n=56). Multiple linear regression analysis showed that proximal plaques had a higher %lipid content, independently of other coronary risk factors and plaque burden (P<0.01). Conclusions:The %lipid and %fibrosis contents differ significantly between plaques in the proximal segment and those in the distal segment of the LAD. (Circ J 2010; 74: 142 - 147)

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“…Autoptical studies endorsed the plaque rupture incidence approximately at 75% (10,11). A higher prevalence of plaque rupture is comprehensible, as demonstrated by Dr. Higuma plaque rupture is correlated with an impaired myocardial blush and slow flow leading to a worse acute prognosis of these patients and probably more often to death.…”

Section: Editorial Clinical Perspective Of Optical Coherence Tomograpmentioning

confidence: 95%

Clinical perspective of optical coherence tomography and intravascular ultrasound in STEMI patients

et al. 2016

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In the last years, the intravascular ultrasound study (IVUS) and further the optical coherence tomography (OCT) became two helpful tools to characterize of the atherosclerotic plaque.These new technologies made possible to analyse in vivo the pathophysiologic mechanisms that previously were just speculated or observed post-mortem (1). Recently Dr. Higum and Prof. Jang published an interesting article named "A combined OCT and IVUS on plaque rupture, plaque erosion and calcified nodule in patients with STEMI", useful to describe the different presentation of culprit lesions in STelevation myocardial infarction (2).In this paper the authors describe the findings about 112 STEMI patients who underwent to OCT and IVUS. Incidence of plaque rupture (PR) was 64.3%, plaque erosion (PE) 26.8% and calcified nodule (CN) 8%. The highlight hallmarks of PR were a higher lipid content inside the plaque, major thin-cap fibroatheroma (TCFA) and more numerous microchannels, with a trend toward a positive remodelling of plaque. PE showed less "vulnerable" morphology of plaque because of lower degree of TCFA, lipid content of plaque and microchannels. The structure of lesion with PE was more eccentric than PR and this was observed better through IVUS rather than OCT. CN lesions demonstrated higher amount of calcium compared to the other lesions, arranged like a "calcium sheet" along with negative remodelling of plaque. After primary Percutaneous Coronary Intervention (PCI) PR was associated with higher rate of myocardial blush grade ≤1 and consequently with a larger incidence of no reflow because of elevated thrombogenic burden enhancing in situ-thrombosis and distal embolization, confirmed by the higher creatinine kinase (CK) peak in PR lesions respect to the others kinds.The population was rather homogeneous, apart from difference in ages. Patients with CN were of older age with a larger significative incidence of diabetes mellitus, that was a factor causing increased degree of vessel calcification as already shown in different setting of patients (3). Unfortunately, the incidence of another factor of progressive and widespread calcification like chronic kidney disease (CKD) wasn't reported.Patients with culprit lesions characterized by PE were younger that those with PR, without relationship with gender. However, OCT and IVUS have showed some discrepancy due to its unclear definition and morphological criteria, so much that it in this study was just considered as a diagnosis of exclusion (4).The results of this study confirmed the prevalence of PR in patients with STEMI and the elevated incidence of TCFA as risk factor of evolution toward myocardial infarction. A meta-analysis recently published by of our group (5) including 23 studies and 2,711 culprit lesions attested that at the observation through OCT the presence of PR and TCFA at 70.4% and 76.6% respectively, in STEMI patients (Figure 1). On the other side, in the others subsets of coronary artery disease the incidence of both these parameters resulted to be less importan...

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Frequency and Distribution of Thin-Cap Fibroatheroma and Ruptured Plaques in Human Coronary Arteries

Abstract: The suspected precursors of rupture-mediated thrombosis occur in a limited, focal distribution in the coronary arteries.

Cited by 325 publications

References 49 publications

2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation

2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation

Plaque Location in the Left Anterior Descending Coronary Artery and Tissue Characteristics in Angina Pectoris: An Integrated Backscatter Intravascular Ultrasound Study

Clinical perspective of optical coherence tomography and intravascular ultrasound in STEMI patients

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