Plaque characteristics and arterial remodeling in coronary and peripheral arterial systems

Abstract

Background Few studies have examined plaque characteristics among multiple arterial beds in vivo. The purpose of this study was to compare the plaque morphology and arterial remodeling between coronary and peripheral arteries using gray-scale and radiofrequency intravascular ultrasound (IVUS) at clinical presentation. Methods and Results IVUS imaging was performed in 68 patients with coronary and 93 with peripheral artery lesions (29 carotid, 50 renal, and 14 iliac arteries). Plaques were classified as fibroatheroma (VH-FA) (further subclassified as thin-capped [VH-TCFA] and thick-capped [VH-ThCFA]), fibrocalcific plaque (VH-FC) and pathological intimal thickening (VH-PIT). Plaque rupture (13% of coronary, 7% of carotid, 6% of renal, and 7% of iliac arteries; P=NS) and VHTCFA (37% of coronary, 24% of carotid, 16% of renal, and 7% of iliac arteries; p=0.02) were observed in all arteries. Compared with coronary arteries, VH-FA was less frequently observed in renal (p<0.001) and iliac arteries (p<0.006). Lesions with positive remodeling demonstrated more characteristics of VH-FA in coronary (84% vs. 25%, p<0.001), carotid (72% vs. 20%, p=0.001), and renal arteries (42% vs. 4%, p=0.001) compared with those with intermediate/negative remodeling. There was positive relationship between RI and percent necrotic area in all four arteries. Conclusions Atherosclerotic plaque phenotypes were heterogeneous among four different arteries; renal and iliac arteries had more stable phenotypes compared with coronary artery. In contrast, the associations of remodeling pattern with plaque phenotype and composition were similar among the various arterial beds.

The association between expansive arterial remodeling detected by high-resolution MRI in carotid artery stenosis and clinical presentation

“…2,14,23 Matsuo et al investigated plaque characteristics and arterial remodeling using intravascular ultrasonography in coronary and peripheral arteries such as the carotid, renal, and iliac arteries, and reported that arteries with ER, compared with those with negative remodeling, demonstrated more characteristics of fibroatheroma, which is one of the most significant features of vulnerable plaque regardless of its location. 20 There have been 2 previous studies that used multidetector CT angiography to investigate the association between ER in the CA and clinical presentation. 13,21 The purpose of this study was to assess the feasibility of longaxis CA MRI 33 for quantitative assessment of ER and to evaluate the association between the extent of ER and cerebral ischemic events.…”

Osteogenic monocytes within the coronary circulation and their association with plaque vulnerability in patients with early atherosclerosis

“…Following angiography, greyscale and VH-IVUS were performed using phased-array 20 MHz IVUS catheters and the S5 Imaging System (Eagle-Eye Gold, Volcano Corporation, Rancho Cordova, California) in the left anterior descending artery (LAD), [8, 12, 19–21]. The image examination was performed by a blinded observer in the IVUS Imaging center at Mayo Clinic, Rochester.…”

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“…16,18 One of the most often studied findings associated with plaque vulnerability is arterial remodeling. Initially described by Glagov et al 19 in 1987, the positive arterial remodeling has been observed in atherosclerotic plaques responsible for acute coronary events, 6,20,21 and is associated with the increase in CK-MB after PCI, 22 no-reflow phenomena during primary PCI, 23 recurrent ischemia after PCI, 24 major cardiovascular events in patients with unstable angina undergoing any form of revascularization, 25 and intimal hyperplasia after PCI with bare-metal 26 and drug-eluting stents. 27 In the present study, the mean arterial-remodeling index was 1.4 ± 1.0, greater than 1.05, thus characterizing the predominance of positive arterial remodeling and corroborating the aforementioned literature.…”

“…4,5 The IVUS identifies plaque and calcium nodule rupture with high sensitivity and specificity. Additionally, several findings at IVUS are characteristic of unstable plaques, such as extensive positive remodeling 6 and the presence of small amounts of calcium with localized and scattered distribution (spotty calcification). 7,8 Recently, the application of tissue characterization with the iMAP™ technology (Boston Scientific, Santa Clara, United States) made further progress in the identification of atherosclerotic plaque composition, identifying and quantifying the lipidic and necrotic contents, which are directly related to lesion instability.…”