The Dynamic Nature of Coronary Artery Lesion Morphology Assessed By Serial Virtual Histology Intravascular Ultrasound Tissue Characterization

OBJECTIVES: We used virtual histology intravascular ultrasound (VH-IVUS) to investigate the natural history of coronary artery lesion morphology. Plaque stability is related to its histological composition.

METHODS: We performed serial (baseline and 12-month follow-up) VH-IVUS studies and examined 216 nonculprit lesions (plaque burden >40%) in 99 patients. Lesions were classified into pathological intimal thickening (PIT), VH-IVUS-derived thin-capped fibroatheroma (VH-TCFA), thick-capped fibroatheroma (ThCFA), fibrotic plaque, and fibrocalcific plaque.

RESULTS: At baseline, 20 lesions were VH-TCFAs; during follow-up, 15 (75%) VH-TCFAs “healed,” 13 became ThCFAs, 2 became fibrotic plaque, and 5 (25%) VH-TCFAs remained unchanged. Compared with VH-TCFAs that healed, VH-TCFAs that remained VH-TCFAs located more proximally (values are median [interquartile range]) (16 mm [15 to 18 mm] vs. 31 mm [22 to 47 mm], p = 0.013) and had larger lumen (9.1 mm(2) [8.2 to 10.7 mm(2)] vs. 6.9 mm(2) [6.0 to 8.2 mm(2)], p = 0.021), vessel (18.7 mm(2) [17.3 to 28.6 mm(2)] vs. 15.5 mm(2) [13.3 to 16.6 mm(2)]; p = 0.010), and plaque (9.7 mm(2) [9.6 to 15.7 mm(2)] vs. 8.4 mm(2) [7 to 9.7 mm(2)], p = 0.027) areas; however, baseline VH-IVUS plaque composition did not differ between VH-TCFAs that healed and VH-TCFAs that remained VH-TCFAs. Conversely, 12 new VH-TCFAs developed; 6 late-developing VH-TCFAs were PITs, and 6 were ThCFAs at baseline. In addition, plaque area at minimum lumen sites increased significantly in PITs (7.8 mm(2) [6.2 to 10.0 mm(2)] to 9.0 mm(2) [6.5 to 12.0 mm(2)], p < 0.001), VH-TCFAs (8.6 mm(2) [7.3 to 9.9 mm(2)] to 9.5 mm(2) [7.8 to 10.8 mm(2)], p = 0.024), and ThCFAs (8.6 mm(2) [6.8 to 10.2 mm(2)] to 8.8 mm(2) [7.1 to 11.4 mm(2)], p < 0.001) with a corresponding decrease lumen areas, but not in fibrous or fibrocalcific plaque.

CONCLUSIONS: Most VH-TCFAs healed during 12-month follow-up, whereas new VH-TCFAs also developed. PITs, VH-TCFAs, and ThCFAs showed significant plaque progression compared with fibrous and fibrocalcific plaque. Marcus Williams Womens Jersey

PMID: 20378076

Posted in Invasive Imaging and tagged , , , , , .

2 Comments

  1. Interesting data, showing the temporary nature of ‘vulnerable’ plaques!

    See the recent post of April 20th:

    Composition of Carotid Atherosclerotic Plaque Is Associated With Cardiovascular Outcome: A Prognostic Study.
    Circulation. 2010; 121(4):1941-1950.
    Willem E. Hellings, Wouter Peeters, Frans L. Moll, Sebastiaan R.D. Piers, Jessica van Setten, Peter J. Van der Spek, Jean-Paul P.M., et al.
    PMID:

  2. Very interesting data!

    One question that I had while reading it, was if there were any differences in plaque evolution between groups of patients with specific characteristics, such as diabetes, tobacco abuse, or the use of certain medications (53 of the 99 were on statins!).

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