Relationship between coronary artery remodeling and plaque vulnerability

Abstract

Background-In vivo studies with intravascular ultrasound have shown that complex plaque anatomy and plaque rupture are more frequent in the presence of marked outward remodeling. A large lipid core and a high macrophage count are recognized histological markers for plaque vulnerability. The link between plaque vulnerability in terms of these markers and remodeling in coronary arteries has not been explored. Methods and Results-In 88 male subjects who died suddenly with coronary artery disease, 108 plaques were studied. The percent remodeling was calculated. Lesions with remodeling Ն0% were considered to have positive remodeling, and those in which remodeling was Ͻ0% were considered to have negative remodeling. Percent lipid core and macrophage count at the plaque were assessed.

Imaging Techniques for the Assessment of Coronary Arteries in Diabetic Patients Undergoing PCI with Bioresorbable Vascular Scaffolds

“…One characteristic of coronary artery remodeling is that in negative remodeling the plaque distribution is circumferential, while in positive remodeling the distribution of the plaque is mostly excentric. 5 In IVUS studies, the negative remodeling index was under 0.95, compared with positive remodeling where the remodeling index was below 1.05. Plaque calcium appears with shadowing and hyperechoic.…”

“…In case of negative remodeling, lesions can be associated with a higher degree of stenosis. 5 Positive remodeling was shown to be related to acute coronary syndromes, and the external elastic membrane at the lesion site was larger compared with the reference segment; negative coronary remodeling is responsible for stenosis in patients with stable angina, and the external elastic membrane at the lesion site is much smaller compared to the reference segment. 6 By using IVUS, it was discovered that vessel shrinkage is correlated with a more circumferential distribution of the atheromatous plaque.…”

“…In this type of remodeling, identifying the plaques at high risk of rupture could help us consider this a marker for intervention. 5 …”

Expansion of the Clinical Application of Optical Coherence Tomography to Percutaneous Coronary Intervention and Assessment of the Instability of Coronary Atherosclerosis

“…4 Furthermore, autopsy studies have shown that positive remodeling is associated with underlying lesions with the histological characteristics of plaque vulnerability, such as a large lipid core and high plaque macrophage content. 5 Under these conditions, OCT is not suitable for assessment of positive remodeling because of its limited penetration depth in a large vessel with plaque containing a large lipid core. Gray-scale IVUS remains the standard for assessing vessel dimensions and plaque volume and is the modality of choice for evaluating vessel remodeling; however, it has limited value for evaluating plaque characteristics such as lipid content.…”

Computed tomography-based diagnosis of diffuse compensatory enlargement of coronary arteries using scaling power laws

“…Glagov's positive remodelling) along the epicardial coronary arterial tree [2]. The positive remodelling may make the plaque vulnerable to rupture and potentially cause subsequent acute events [3].…”