Lipid-rich plaque and myocardial perfusion after successful stenting in patients with non-ST-segment elevation acute coronary syndrome: an optical coherence tomography study

Tanaka, Atsushi; Imanishi, Toshio; Kitabata, Hironori; Kubo, Takashi; Takarada, Shigeho; Tanimoto, Takashi; Kuroi, Akio; Tsujioka, Hiroto; Ikejima, Hideyuki; Komukai, Kenichi; Kataiwa, Hideaki; Okouchi, Keishi; Kashiwaghi, Manabu; Ishibashi, Keiichiro; Matsumoto, Hiroki; Takemoto, Kazushi; Nakamura, Nobuo; Hirata, Kumiko; Mizukoshi, Masato

doi:10.1093/eurheartj/ehp122

Cited by 170 publications

(93 citation statements)

References 36 publications

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“…1,17,23 In addition, OCT can identify TCFA by measuring the thickness of the fibrous cap and the arc of the lipid-rich plaque. [24][25][26] Lipid pools are less sharply delineated than calcification and show lower signal intensity. Lipids also exhibit more heterogeneous backscattering than fibrous plaques.…”

Section: Plaque Characterisationmentioning

confidence: 99%

“…25,26,30 OCT images for white thrombi (composed of platelets and leucocytes) produce a signal-rich mass whereas red thrombi (containing mainly erythrocytes) produce high backscattering protrusions with strong signal attenuation. 31 If there is a large red thrombus, then this may interrupt the visualisation of the characteristics of an underlying plaque due to signal attenuation.…”

Section: Thrombusmentioning

confidence: 99%

“…Stent area measured by OCT could potentially be an alternative endpoint of PCI. This is because OCT has helped to predict no reflow 26 post-PCI, based on the presence of TCFA. The clinical significance of these OCT findings and whether they warrant further intervention remains unclear; with a small natural history study showing that these findings resolved without significant restenosis or thrombus formation at six-month follow-up.…”

Section: Optimising Percutaneous Coronary Interventionmentioning

confidence: 99%

“…lipid-rich, fibrous and calcified plaques). 25,26 However, in several applications, the shallower penetration of OCT may be a drawback. Whole vessel structures, including the external elastic lamina, cannot be visualised consistently by OCT, especially through lesions with a high amount of lipid-rich plaque burden.…”

Section: Comparison Of the Two Techniquesmentioning

confidence: 99%

See 3 more Smart Citations

Intravascular Ultrasound Versus Optical Coherence Tomography for Coronary Artery Imaging – Apples and Oranges?

Rathod¹,

Hamshere²,

Jones³

et al. 2015

Interventional Cardiology Review

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Coronary angiography has been the gold standard technique for evaluating coronary arterial disease for the past 50 years. Increasingly, however, realisation of the limitations of coronary angiography, mainly the inability to supply information regarding the coronary wall, has prompted the design and development of adjunctive technologies to better evaluate not just luminal disease but also the burden and character of atherosclerotic plaque within the vessel. The development of intracoronary imaging modalities, namely intravascular ultrasound (IVUS) and optical coherence tomography (OCT), has progressed quickly and these technologies now have established roles in the diagnosis and treatment of coronary artery disease. In general, intracoronary devices that can assess the coronary endothelium use either acoustic or optical signals that are received by a coronary catheter (IVUS uses ultrasound, OCT uses near-infrared light).This review addresses these two widely used intracoronary imaging techniques, looking at their clinical applications, recent evidence for their use and describes new developments in the field. Intravascular UltrasoundIn the last 25 years IVUS has been established as the most commonly used intracoronary imaging device. An IVUS system consists of a flexible monorail catheter with an ultrasound transducer at its tip that emits ultrasound waves in the 10-40 MHz range and an electronics console to reconstruct the image (see Figure 1).1 After reflection from tissue, part of the ultrasound energy returns to the transducer and is converted into the image.There are two types of IVUS transducers for clinical use: the mechanical rotating transducer and the electronically switched phased array system.The mechanical transducer uses a single crystal on a rotational device, which visualises the entire vessel in cross-section providing better image quality (compared with phased array technology) of 100-150 μm.2 The main disadvantage of mechanical transducers is the central drive shaft that decreases flexibility and prevents the concurrent use of a central guidewire.3 However, newer rotational IVUS catheters have developed a monorail system that allows for the presence of a central guidewire.Phased array catheters use multiple transducer elements, which are mounted along the circumference of the catheter tip. Each element sends and receives ultrasounds from a sector and multiple sectors are gathered to produce a cross-sectional image of the artery. However, they are disadvantaged by a technically complex set-up, requiring detailed programming; 3 but some of the newer catheters are easier to set up.Intracoronary imaging of coronary vessels by IVUS is performed using standard coronary interventional techniques and equipment (guiding catheter and 0.014 inch angioplasty guidewire) for catheter delivery along the guidewire beyond the target lesion/area of interest. Intravenous heparin and glyceryl trinitrate (nitroglycerin) are routinely administered before imaging. The IVUS catheter is then drawn back across the tar...

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Section: Plaque Characterisationmentioning

confidence: 99%

Section: Thrombusmentioning

confidence: 99%

Section: Optimising Percutaneous Coronary Interventionmentioning

confidence: 99%

Section: Comparison Of the Two Techniquesmentioning

confidence: 99%

See 2 more Smart Citations

Intravascular Ultrasound Versus Optical Coherence Tomography for Coronary Artery Imaging – Apples and Oranges?

Rathod¹,

Hamshere²,

Jones³

et al. 2015

Interventional Cardiology Review

View full text Add to dashboard Cite

show abstract

“…Tanaka et al showed that TCFA was often observed at target lesions of the patients with no reflow after PCI compared with good reflow (50% versus 16%, P = 0.005). The frequency of the no reflow phenomenon increased according to the lipid arc assessed by OCT [11]. When OCT detects lipid-rich plaque and TCFA especially in patients with ACS, we should consider to use distal protection devices to prevent no-reflow phenomenon.…”

Section: Clinical Applications Of Oct Imagingmentioning

confidence: 99%

Clinical and Research Applications of Optical Coherence Tomography Imaging in Coronary Artery Disease

Hasegawa¹,

Shimada²

2013

What Should We Know About Prevented, Diagnostic, and Interventional Therapy in Coronary Artery Disease

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Disparity between angiographic coronary lesion complexity and lipid core plaques assessed by near‐infrared spectroscopy

Zynda

Thompson²,

Hoang

et al. 2012

Cathet Cardio Intervent

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Angiographic SYNTAX score only weakly correlated with LCBI. It is of interest as well that high LCBI was also present in cases of low SYNTAX scores. The disparity between the degree of angiographic complexity and the amount of LCP supports postulated mechanisms of the adverse event propensity even in patients who demonstrate low angiographic complexity. Future studies are necessary to address the clinical significance of high LCBI in patients with low-to-intermediate angiographic complexity and their potential for PCI-related complications.

show abstract

Lipid-rich plaque and myocardial perfusion after successful stenting in patients with non-ST-segment elevation acute coronary syndrome: an optical coherence tomography study

Cited by 170 publications

References 36 publications

Intravascular Ultrasound Versus Optical Coherence Tomography for Coronary Artery Imaging – Apples and Oranges?

Intravascular Ultrasound Versus Optical Coherence Tomography for Coronary Artery Imaging – Apples and Oranges?

Clinical and Research Applications of Optical Coherence Tomography Imaging in Coronary Artery Disease

Disparity between angiographic coronary lesion complexity and lipid core plaques assessed by near‐infrared spectroscopy

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