Assessment of Culprit and Remote Coronary Narrowings Using Optical Coherence Tomography With Long-Term Outcomes

Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
The American Journal of Cardiology (Impact Factor: 3.28). 08/2008; 102(4):391-5. DOI: 10.1016/j.amjcard.2008.03.071
Source: PubMed


Much currently known information about vulnerable plaque stems from postmortem studies that identified several characteristics making them prone to rupture, including the presence of a thin fibrous cap and a large lipid core. This study used optical coherence tomography (OCT) to assess culprit and remote coronary narrowings and investigate whether intracoronary OCT in living patients was able to visualize morphologic features associated with vulnerable plaque in postmortem studies. Twenty-three patients successfully underwent OCT before percutaneous coronary intervention. The culprit lesion and mild to moderate coronary narrowings remote from the target stenosis were investigated. Using OCT, the culprit lesion was found to be fibrous in 39.1%, fibrocalcific in 34.4%, and lipid rich in 26.1% of cases. Two patients met criteria for thin-cap fibroatheroma (TCFA; defined as the presence of a signal-rich fibrous cap covering a signal-poor lipid/necrotic core with cap thickness <0.2 mm). Most plaques at remote segments were proximal to the culprit lesion (73.9%) and predominantly fibrous and lipid rich. OCT identified 7 TCFA lesions in 6 patients with a mean cap thickness of 0.19 +/- 0.05 mm, extending for 103 degrees +/- 49 degrees of the total vessel circumference. At 24 months of clinical follow-up, the only event occurred in a patient with in-stent restenosis who underwent repeated percutaneous revascularization. There were no clinically apparent plaque rupture-related events in the 6 patients found to have remote TCFA. This study showed that OCT can be safely applied to image beyond the culprit lesion and can detect in vivo morphologic features associated with plaque vulnerability using retrospective pathologic examination. In conclusion, detection of TCFA, particularly in stable patients, is desirable and may principally allow for early intervention and prevention of adverse events.

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    • "Their results showed a significantly higher incidence of intimal laceration (61.5% versus 8.9%), microchannels (76.9% versus 14.3%), lipid pools (100% versus 60.7%), thin cap fibroatheroma (76.9% versus 14.3%), macrophage image (61.6% versus 14.3%), and intraluminal thrombus (30.8% versus 1.8%) in NSCPs with progression than those with NSCPs without progression (P < 0.05 for all of these comparisons). Barlis et al. showed that OCT could be safely used in vivo to show the culprit coronary lesions and detect morphologic features associated with plaque vulnerability [71]. During 24 months of follow-up of 23 patients prior to coronary angioplasty, OCT detected 7 thin cap fibroatheroma lesions in 6 patients with a mean cap thickness of 0.19 ± 0.05 mm. "
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    • "Atherosclerotic plaque in the coronary tree may manifest as either an acute coronary syndrome (ACS) or stable angina pectoris. An ACS is long thought to be triggered by the rupture of vulnerable atherosclerotic plaque.1 2 The hallmark of the so-called ‘vulnerable plaque’ is a thin-cap fibroatheroma (TCFA) with macrophage infiltration surrounding a lipid-rich necrotic core.3–6 This is in contrast to patients with stable angina pectoris who may have coronary flow-limiting vulnerable plaque without acute plaque rupture.7 Autopsy studies suggest that it is the rupture of these vulnerable plaques with TCFA that cause coronary events. "
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    • "A special entity of vulnerable plaques is the 'thin-cap fibroatheroma' (TCFA). The outstanding capacity of OCT to measure fibrous cap thickness makes it well-suited for the in vivo detection of TCFA [14]. In one report, OCT allowed the diagnosis of TCFA with a sensitivity of 90%, and a specificity of 79%, as compared with histopathology [15]. "
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