Impact of plaque components on no-reflow phenomenon after stent deployment in patients with acute coronary syndrome: a virtual histology-intravascular ultrasound analysis

Abstract

AimsWe used virtual histology-intravascular ultrasound (VH-IVUS) to evaluate the relation between coronary plaque characteristics and no-reflow in acute coronary syndrome (ACS) patients.Methods and resultsA total of 190 consecutive ACS patients were imaged using VH-IVUS and analysed retrospectively. Angiographic no-reflow was defined as TIMI flow grade 0, 1, and 2 after stenting. Virtual histology-intravascular ultrasound classified the colour-coded tissue into four major components: fibrotic, fibro-fatty, dense calcium, and necrotic core (NC). Thin-cap fibroatheroma (TCFA) was defined as focal, NC-rich (≥10% of the cross-sectional area) plaques being in contact with the lumen in a plaque burden ≥40%. Of the 190 patients studied at pre-stenting, no-reflow was observed in 24 patients (12.6%) at post-stenting. The absolute and %NC areas at the minimum lumen sites (1.6 ± 1.2 vs. 0.9 ± 0.8 mm2, P < 0.001, and 24.5 ± 14.3 vs. 16.1 ± 10.6%, P = 0.001, respectively) and the absolute and %NC volumes (30 ± 24 vs. 16 ± 17 mm3, P = 0.001, and 22 ± 11 vs. 14 ± 8%, P < 0.001, respectively) were significantly greater, and the presence of at least one TCFA and multiple TCFAs within culprit lesions (71 vs. 36%, P = 0.001, and 38 vs. 15%, P = 0.005, respectively) was significantly more common in the no-reflow group compared with the normal-reflow group. In the multivariable analysis, %NC volume was the only independent predictor of no-reflow (odds ratio = 1.126; 95% CI 1.045–1.214, P = 0.002).ConclusionIn ACS patients, post-stenting no-reflow is associated with plaque components defined by VH-IVUS analysis with larger NC and more TCFAs.

Plaque characteristics and serum pregnancy-associated plasma protein A levels predict the no-reflow phenomenon after percutaneous coronary intervention

“…Plaque rupture, which is another common sign of plaque instability, has been found to be closely related to noreflow in patients with ST-segment elevation myocardial infarction. 24,25 In addition, the fibrofatty volume detected by VH-IVUS and lipid-rich plaque assessed by IB-IVUS have been reported to be important predictors of coronary no-reflow after PCI, 4,14 while others have shown that only the percentage of necrotic core and thincap fibroatheroma were predictive of noreflow after PCI. 26 These discrepancies may be attributable to the different patient populations, as some studies were performed in patients with acute myocardial infarction, while others included both patients with acute myocardial infarction and those with unstable angina.…”

Rationale of decreasing low-density lipoprotein cholesterol below 70 mg/dL in patients with coronary artery disease: A retrospective virtual histology. Intravascular ultrasound study

“…It is associated with no-reflow phenomenon during PCI [10], positive coronary artery remodeling [11], clinical presentation feature such as acute coronary syndrome [12], high strain site [13] and localized endothelial dysfunction [14]. All of the above features are associated with worse clinical presentation or prognosis in patients with CAD.…”

New Modality for Evaluating Plaque Characteristics of the Culprit Lesion in a Patient With Acute Coronary Syndrome and No Reflow Phenomenon

“…6) Meanwhile, Hong, et al reported that the percentage of necrotic core volume through the entire culprit lesion segment was the only independent predictor of no reflow in ACS patients, as determined by multivariable analysis. 7) On the other hand, Nakamura, et al reported that the presence of a "marble-like" image, consisting mainly of fibrofatty and fibrous plaque, was significantly associated with angiographic no reflow in acute myocardial infarction (AMI) patients. 8) Similarly, Bae, et al also used multivariable analysis for AMI patients and found that fibrofatty volume over the entire culprit lesion length was the only independent factor for no reflow during primary PCI.…”

“…3,4) Furthermore, spectral analysis of IVUS radiofrequency (RF) data has been employed to assess plaque composition, 5) however, the results to evaluate the culprit lesion with and without no reflow phenomenon have been controversial. [6][7][8][9] Here, we report the first clinical case of a new spectral similarity of RF IVUS signals for the evaluation of the culprit plaque characteristics in a patient with acute coronary syndrome and no reflow phenomenon.…”