Multiple Atherosclerotic Plaque Rupture in Acute Coronary Syndrome

Abstract

Background-To test the hypothesis of general atherosclerotic plaque destabilization during acute coronary syndrome (ACS), the present study sought to analyze the 3 coronary arteries by systematic intravascular ultrasound scan (IVUS). Methods and Results-Seventy-two arteries were explored in 24 patients referred for percutaneous coronary intervention after a first ACS with troponin I elevation. Fifty plaque ruptures (mean, 2.08 per patient; range, 0 to 6) were diagnosed by the association of a ruptured capsule with intraplaque cavity. Plaque rupture on the culprit lesion was found in 9 patients (37.5%). At least 1 plaque rupture was found somewhere other than on the culprit lesion in 19 patients (79%). These lesions were in a different artery than the culprit artery in 70.8% and were in both other arteries in 12.5% of these 24 patients. Complete IVUS examination of all 3 coronary axes in patients who had experienced a first ACS revealed that multiple atherosclerotic plaque ruptures were detected by IVUS; these multiple ruptures were present simultaneously with the culprit lesion; they were frequent and located (in three quarters of cases) on the 3 principal coronary trunks; and the multiple plaque ruptures in locations other than on the culprit lesion were less severe, nonstenosing, and less calcified. Conclusion-Although one single lesion is clinically active at the time of ACS, the syndrome seems nevertheless associated with overall coronary instability. (Circulation. 2002;106:804-808.)

Inflammation as a Possible Link Between Coronary and Carotid Plaque Instability

“…13 Serial or diffuse complex lesions were defined as multiple. 1,2 The local ethics committee approved the protocol. All patients enrolled in the prospective study gave their informed consent to the use of some of their blood for the study.…”

Intravascular Ultrasound Assessment of Ulcerated Ruptured Plaques

“…[1][2][3] One intravascular ultrasound (IVUS) study reported a high incidence of multiple plaque ruptures in ACS patients. 4 Another IVUS study showed that plaque ruptures occur not only in ACS patients but also in patients with stable angina or asymptomatic ischemia. 5 Furthermore, pathological studies reported plaque ruptures in coronary arteries of patients with noncardiac death.…”

Vulnerable Atherosclerotic Plaque

“…The finding of more than 1 ruptured or vulnerable plaque in patients with MI or unstable angina is also supported by a recent intravascular ultrasound study by Riofoul et al, 33 who found 2 or more plaque ruptures in 79% of patients with acute coronary syndromes. However, another study described a single plaque rupture in half of patients who presented with unstable angina.…”