NIRS-IVUS for Differentiating Coronary Plaque Rupture, Erosion, and Calcified Nodule in Acute Myocardial Infarction

Terada, Kosei; Kubo, Takashi; Kameyama, Takeyoshi; Matsuo, Yoshiki; Ino, Yasushi; Emori, Hiroki; Higashioka, Daisuke; Katayama, Yosuke; Khalifa, Amir Kh. M.; Takahata, Masahiro; Shimamura, Kazuo; Shiono, Yasutsugu; Tanaka, Atsushi; Hozumi, Takeshi; Madder, Ryan D.

doi:10.1016/j.jcmg.2020.08.030

Cited by 31 publications

(30 citation statements)

References 15 publications

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“…Previous studies have shown that patients with PE have fewer lipid plaques, thicker fibrous caps, smaller lipid arcs, and shorter lipid lengths than those with PR (1,4,83). Besides, ruptured plaques release highly thrombogenic substrates, inducing recurrent local thrombosis and distal embolization.…”

Section: Clinical Strategies and Outcomes In Patients With Pementioning

confidence: 99%

“…There is evidence indicating that it is not only the rupture of the fibrous cap of lipid plaques that could lead to acute thrombosis and sudden cardiac death. According to recent studies (1,4,7,8), approximately one-third of the cases of ST-segment elevation myocardial infarction (STEMI) did not present with PR, but rather, exhibited PE. Autopsy and imaging studies indicate that PE manifests different pathological features from those of PR (Figure 1).…”

Section: Pathological Features Of Eroded Plaquesmentioning

confidence: 99%

“…Acute coronary syndrome (ACS) is a common and highly fatal cardiovascular disease. It has been considered that the rupture of atherosclerotic vulnerable plaques is the main pathological mechanism of ACS (1). Some progress has been made in the understanding of the pathogenesis and development of preventive measures against so-called "vulnerable plaques" (2,3).…”

Section: Introductionmentioning

confidence: 99%

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Plaque Erosion: A Distinctive Pathological Mechanism of Acute Coronary Syndrome

Luo

Bai

et al. 2021

Front. Cardiovasc. Med.

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Plaque erosion (PE) is one of the most important pathological mechanisms underlying acute coronary syndrome (ACS). The incidence of PE is being increasingly recognized owing to the development and popularization of intracavitary imaging. Unlike traditional vulnerable plaques, eroded plaques have unique pathological characteristics. Moreover, recent studies have revealed that there are differences in the physiopathological mechanisms, biomarkers, and clinical outcomes between PE and plaque rupture (PR). Accurate diagnosis and treatment of eroded plaques require an understanding of the pathogenesis of PE. In this review, we summarize recent scientific discoveries of the pathological characteristics, mechanisms, biomarkers, clinical strategies, and prognosis in patients with PE.

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Section: Clinical Strategies and Outcomes In Patients With Pementioning

confidence: 99%

Section: Pathological Features Of Eroded Plaquesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Plaque Erosion: A Distinctive Pathological Mechanism of Acute Coronary Syndrome

Luo

Bai

et al. 2021

Front. Cardiovasc. Med.

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“…NIRS can compensate for the lack of IVUS ability to detect plaque erosion. Plaque erosion has a significantly lower maxLCBI4mm than plaque rupture and calcified nodule ( 12 , 13 ). The optimal cutoff value for maxLCBI4mm to differentiate between plaque erosion and other plaque types is ~400 ( 12 ).…”

Section: Nirsmentioning

confidence: 99%

“…The optimal cutoff value for maxLCBI4mm to differentiate between plaque erosion and other plaque types is ~400 ( 12 ). By assessing plaque cavity, convex calcium, and maxLCBI4mm, NIRS-IVUS can accurately identify plaque rupture (sensitivity = 97% and specificity = 96%), plaque erosion (sensitivity = 93% and specificity = 99%), and calcified nodule (sensitivity = 100% and specificity = 99%) ( 13 ).…”

Section: Nirsmentioning

confidence: 99%

Combined Use of Multiple Intravascular Imaging Techniques in Acute Coronary Syndrome

Kubo

Terada

Ino

et al. 2022

Front. Cardiovasc. Med.

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Recent advances in intravascular imaging techniques have made it possible to assess the culprit lesions of acute coronary syndrome (ACS) in the clinical setting. Intravascular ultrasound (IVUS) is the most commonly used intravascular imaging technique that provides cross-sectional images of coronary arteries. IVUS can assess plaque burden and vessel remodeling. Optical coherence tomography (OCT) is a high-resolution (10 μm) intravascular imaging technique that uses near-infrared light. OCT can identify key features of atheroma, such as lipid core and thin fibrous cap. Near-infrared spectroscopy (NIRS) can detect lipid composition by analyzing the near-infrared absorption properties of coronary plaques. NIRS provides a chemogram of the coronary artery wall, which allows for specific quantification of lipid accumulation. These intravascular imaging techniques can depict histological features of plaque rupture, plaque erosion, and calcified nodule in ACS culprit lesions. However, no single imaging technique is perfect and each has its respective strengths and limitations. In this review, we summarize the implications of combined use of multiple intravascular imaging techniques to assess the pathology of ACS and guide lesion-specific treatment.

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Culprit lesion plaque characterization and thrombus grading by high‐definition intravascular ultrasound in patients with ST‐segment elevation myocardial infarction

Groenland

Plantes

Neleman

et al. 2023

Cathet Cardio Intervent

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Background Dedicated prospective studies investigating high‐definition intravascular ultrasound (HD‐IVUS)‐guided primary percutaneous coronary intervention (PCI) are lacking. The aim of this study was to qualify and quantify culprit lesion plaque characteristics and thrombus using HD‐IVUS in patients presenting with ST‐segment elevation myocardial infarction (STEMI). Methods The SPECTRUM study is a prospective, single‐center, observational cohort study investigating the impact of HD‐IVUS‐guided primary PCI in 200 STEMI patients (NCT05007535). The first 100 study patients with a de novo culprit lesion and a per‐protocol mandated preintervention pullback directly after vessel wiring were subject to a predefined imaging analysis. Culprit lesion plaque characteristics and different thrombus types were assessed. An IVUS‐derived thrombus score, including a 1‐point adjudication for a long total thrombus length, long occlusive thrombus length, and large maximum thrombus angle, was developed to differentiate between low (0–1 points) and high (2–3 points) thrombus burden. Optimal cut‐off values were obtained using receiver operating characteristic curves. Results The mean age was 63.5 (±12.1) years and 69 (69.0%) patients were male. The median culprit lesion length was 33.5 (22.8–38.9) mm. Plaque rupture and convex calcium were appreciated in 48 (48.0%) and 10 (10.0%) patients, respectively. Thrombus was observed in 91 (91.0%) patients (acute thrombus 3.3%; subacute thrombus 100.0%; organized thrombus 22.0%). High IVUS‐derived thrombus burden was present in 37/91 (40.7%) patients and was associated with higher rates of impaired final thrombolysis in myocardial infarction flow (grade 0–2) (27.0% vs. 1.9%, p < 0.001). Conclusions HD‐IVUS in patients presenting with STEMI allows detailed culprit lesion plaque characterization and thrombus grading that may guide tailored PCI.

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NIRS-IVUS for Differentiating Coronary Plaque Rupture, Erosion, and Calcified Nodule in Acute Myocardial Infarction

Cited by 31 publications

References 15 publications

Plaque Erosion: A Distinctive Pathological Mechanism of Acute Coronary Syndrome

Plaque Erosion: A Distinctive Pathological Mechanism of Acute Coronary Syndrome

Combined Use of Multiple Intravascular Imaging Techniques in Acute Coronary Syndrome

Culprit lesion plaque characterization and thrombus grading by high‐definition intravascular ultrasound in patients with ST‐segment elevation myocardial infarction

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