Quantitative angiographic morphology of coronary stenoses leading to myocardial infarction or unstable angina.

Wilson, Robert F.; Holida, Myrl; White, Carl W.

doi:10.1161/01.cir.73.2.286

Cited by 128 publications

(20 citation statements)

References 17 publications

(3 reference statements)

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“…Complex coronary lesions detected by angiography are known to be associated with plaque vulnerability 12,19 and to be predictive of coronary events, such as unstable angina and myocardial infarction. 12,20,21 Complex lesions are common in unstable angina and have been reported in 10-20% of patients with stable angina. 12 In our study, patients with acute myocardial infarction or unstable angina were excluded, but complex lesions were found in 23% of the patients with CAD.…”

Section: Discussionmentioning

confidence: 99%

Plasma Matrix Metalloproteinase-8 Concentrations are Associated With the Presence and Severity of Coronary Artery Disease

Kato

Momiyama

Ohmori

et al. 2005

Circ J

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nterstitial collagen, especially type I, is a major component of atherosclerotic plaques 1-3 and although collagen synthesis is generally upregulated in atherosclerotic plaques, 3 it is the balance between collagen synthesis and breakdown that is important for plaque growth, plaque vulnerability, and vascular remodeling. [4][5][6] The matrix metalloproteinases (MMP) 1, 8 and 13 initiate the collagen breakdown 7 and MMP-8 in particular degrades type I collagen preferentially and more potently than MMP-1 or 9 However, MMP-8, known as neutrophil collagenase, was previously thought to be produced only by neutrophils, which are not commonly present in plaques, but recently, it has been found that endothelial cells, smooth muscle cells, and macrophages in atherosclerotic plaques express and produce Therefore, the present study aimed to elucidate whether or not plasma MMP-8 concentrations are associated with the presence and severity of coronary artery disease (CAD). Circulation Journal Vol.69, September 2005 Methods Study PatientsWe measured the plasma MMP-8 concentration in 250 consecutive patients (mean age 65±8 years, range 40-80) who underwent elective coronary angiography for suspected CAD at the National Defense Medical College Hospital. Patients with myocardial infarction within the past 6 months, those with unstable angina at rest within the past 48 h, or those with a history of percutaneous coronary intervention or coronary artery bypass surgery were excluded, as were those with heart failure, cardiomyopathy or valvular heart disease.Hypertension was defined as blood pressure ≥140/90 mmHg or on relevant medication (122 (49%) patients); hyperlipidemia was defined as total cholesterol >240 mg/dl or relevant medication (65 (26%) patients taking statins); diabetes mellitus was defined as fasting plasma glucose ≥126 mg/dl or on insulin or hypoglycemic drugs.Our study was approved by the institutional Ethics Committee. After giving written informed consent, each patient had a fasting blood sample taken on the morning of the day that angiography was performed. Plasma MMP-8 MeasurementBlood samples were collected in EDTA-containing tubes and the plasma was stored at -80°C. Plasma MMP-8 concentrations were measured by enzyme-linked immunosorbent assay (ELISA) using a commercially available kit (MMP-8 Human Biotrak ELISA System, Amersham

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Section: Discussionmentioning

confidence: 99%

Plasma Matrix Metalloproteinase-8 Concentrations are Associated With the Presence and Severity of Coronary Artery Disease

Kato

Momiyama

Ohmori

et al. 2005

Circ J

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“…One of the important causes of the onset of acute coronary syndrome, based on the pathology images of autopsy cases 13,14 or coronary angiograms, [15][16][17] is thrombogenesis accompanied by atheroma rupture. We have previously observed by light microscopy the coronary arterial thrombi that were extracted using thrombectomy, and we investigated pathologically the components of those coronary artery thrombi.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of the Pathological Images of Coronary Artery Thrombi According to the Infarct-Related Coronary Artery in Acute Myocardial Infarction

Nagata

Usuda

Uchiyama

et al. 2004

Circ J

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ercutaneous coronary intervention (PCI) is an effective treatment in the early phase of acute myocardial infarction (AMI), 1-3 but the unstable plaque and coronary arterial thrombi that are involved in the onset of AMI sometimes induce the no-reflow phenomenon after PCI whereby there is insufficient reperfusion. 4 There is reportedly a high incidence of the no-reflow phenomenon or slow flow in AMI in which the right coronary artery (RCA) is the culprit lesion. [4][5][6] The greater susceptibility of the RCA to developing large thrombi makes successful reperfusion more difficult to achieve. It is possible that the state of the thrombi affects the onset of complications related to PCI, but there have not been any reports investigating the differences in the images of pathological thrombi according to the infarct-related coronary artery.It is now possible to aspirate coronary arterial thrombi using coronary arterial thrombectomy, 7-9 and to evaluate the pathological images in vivo. 10,11 So we investigated the characteristics of the pathological images of coronary arterial thrombi according to the infarct-related coronary artery. Methods SubjectsSubjects were 231 patients with AMI who had sought treatment at Toyama Prefectural Central Hospital during a 30-months period from September 2000 to February 2003 and who had undergone emergency coronary angiography. AMI was diagnosed when chest pain persisted for at least 30 min and the 12-lead ECG confirmed ST elevation of at least 2 mm in at least 2 leads in succession, and there was confirmation by initial coronary angiography of occlusion or sub-occlusion of the infarct-related artery. Of the 199 patients indicated for PCI, 129 underwent thrombectomy. Patients who were scheduled for coronary bypass surgery (multivessel disease and left main trunk lesion), patients who could not undergo coronary arterial thrombectomy because of serious complications (fatal arrhythmia, cardiogenic shock, and pulmonary edema), and patients who had undergone thrombolytic therapy before emergency coronary angiography were excluded from the study. Of the 129 patients who underwent coronary arterial thrombectomy, there were 77 cases in which the coronary artery thrombi could be extracted for study within 24 h of the onset of AMI. Cardiac Catheterization and Coronary InterventionWritten informed consent was obtained from all patients, after the patients and their families were informed of the Background Unstable plaque and coronary arterial thrombi sometimes induce a no-reflow phenomenon after intervention whereby there is sufficient reperfusion. The greater susceptibility of the right coronary artery to development of large thrombi makes successful reperfusion more difficult, therefore the characteristics of the pathological images of coronary arterial thrombi according to the infarct-related coronary artery were investigated. Methods and ResultsCoronary arterial thrombi were extracted from 77 patients with acute myocardial infarction (AMI) using a thrombectomy catheter. The 36 patients had a...

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“…8,11 The importance of these 3 factors needs to be emphasized for the intracranial circulation. [7][8][9][10][11][12][13][14][15][16][17] To our knowledge, the Borgess Medical Center Vertebral Artery Ostium Stenting Registry is the first large prospective study that tries to correlate morphological changes in the VAO plaque and the clinical presentation (groups I-IV) in an attempt to establish a similar relationship between atherosclerotic plaque characteristics and ischemia as seen in other vessels. As expected from atherosclerotic plaque, lesion irregularity correlated with the severity of symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…First, morphological changes at the plaque level (including the severity of stenosis, concentric versus eccentric, smooth versus irregular, haziness, calcification, overhanging, and the presence or absence of a clot at the VAO or intracranially) were classified according to the definitions of these terms set out in coronary literature. [7][8][9][10][11][12] The second key feature noted was the hemodynamic situation of the posterior circulation blood supply, which included: bilateral VAO lesions, defined as any evidence of atherosclerotic stenosis at both VAO, including occlusion but independent of the severity; the presence of tandem lesion, defined as Ͼ50% stenosis at the ipsilateral vertebral artery; basilarization of the vertebral artery, defined as only 1 vertebral artery providing anterograde flow to the basilar artery, attributable to acquired or congenital occlusion of the other vertebral artery intracranially or extracranially; and status of the circle of Willis. Two authors (F.A.A., T.B.)…”

Section: Preintervention Diagnostic Cerebral Angiogrammentioning

confidence: 99%

Vertebral Artery Ostium Atherosclerotic Plaque as a Potential Source of Posterior Circulation Ischemic Stroke

Al-Ali

Barrow

Duan

et al. 2011

Stroke

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Background and Purpose-Although atherosclerotic plaque in the carotid and coronary arteries is accepted as a cause of ischemia, vertebral artery ostium (VAO) atherosclerotic plaque is not widely recognized as a source of ischemic stroke. We seek to demonstrate its implication in some posterior circulation ischemia. Methods-This is a nonrandomized, prospective, single-center registry on consecutive patients presenting with posterior circulation ischemia who underwent VAO stenting for significant atherosclerotic stenosis. Diagnostic evaluation and imaging studies determined the likelihood of this lesion as the symptom source (highly likely, probable, or highly unlikely). Patients were divided into 4 groups in decreasing order of severity of clinical presentation (ischemic stroke, TIA then stroke, TIA, asymptomatic), which were compared with the morphological and hemodynamic characteristics of the VAO plaque. Clinical follow-up 1 year after stenting assessed symptom recurrence. Results-One hundred fourteen patients underwent stenting of 127 lesions; 35% of the lesions were highly likely the source of symptoms, 53% were probable, and 12% were highly unlikely. Clinical presentation correlated directly with plaque irregularity and presence of clot at the VAO, as did bilateral lesions and presence of tandem lesions. Symptom recurrence at 1 year was 2%. Conclusions-Thirty-five percent of the lesions were highly likely the source of the symptoms. A direct relationship between some morphological/hemodynamic characteristics and the severity of clinical presentation was also found. Finally, patients had a very low rate of symptom recurrence after treatment. These 3 observations point strongly to VAO plaque as a potential source of some posterior circulation stroke. (Stroke. 2011;42:2544-2549.)

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Quantitative angiographic morphology of coronary stenoses leading to myocardial infarction or unstable angina.

Cited by 128 publications

References 17 publications

Plasma Matrix Metalloproteinase-8 Concentrations are Associated With the Presence and Severity of Coronary Artery Disease

Plasma Matrix Metalloproteinase-8 Concentrations are Associated With the Presence and Severity of Coronary Artery Disease

Characteristics of the Pathological Images of Coronary Artery Thrombi According to the Infarct-Related Coronary Artery in Acute Myocardial Infarction

Vertebral Artery Ostium Atherosclerotic Plaque as a Potential Source of Posterior Circulation Ischemic Stroke

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