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.
"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 . 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. "
[Show abstract][Hide abstract] ABSTRACT: Invasive angiography has been widely accepted as the gold standard to diagnose cardiovascular pathologies. Despite its superior resolution of demonstrating atherosclerotic plaque in terms of degree of lumen stenosis, the morphological assessment for the plaque is insufficient for the analysis of plaque components, and therefore, unable to predict the risk status or vulnerability of atherosclerotic plaque. There is an increased body of evidence to show that the vasa vasorum play an important role in the initiation, progression, and complications of atherosclerotic plaque leading to major adverse cardiac events. This paper provides an overview of the evidence-based reviews of various imaging modalities with regard to their potential value for comprehensive characterization of the composition, burden, and neovascularization of atherosclerotic plaque.
The Scientific World Journal 02/2014; 2014(5):312764. DOI:10.1155/2014/312764 · 1.73 Impact Factor
"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. "
[Show abstract][Hide abstract] ABSTRACT: Ischaemic heart disease (IHD) remains one of the leading causes of death. Atherosclerosis has been intensely researched given the IHD prevalence and the financial impacts on healthcare systems. More recently, in vivo characterisation of coronary atherosclerotic plaque and tissue responses following stent implantation in a coronary artery has been made possible by a novel technology called optical coherence tomography (OCT). OCT is a light-based, invasive, intracoronary imaging modality long applied to the field of ophthalmology and now in clinical use worldwide. It gives a unique view of within the coronary artery using near-infrared light with a resolution of 15 microns, 10 times higher than other invasive coronary imaging techniques like intravascular ultrasound. The technology is being adopted to comprehensively detect features that make plaques 'vulnerable' (eg, large lipid pool, thin, fibrous-cap atheroma), whether stents are implanted optimally within the artery, and visualise the small layers of tissue that form over stent metal surfaces over time, which in turn may provide surrogate markers for long-term stent safety and help guide the optimal duration of dual antiplatelet therapy, a topic of big discussion at the current point of time.
Heart Asia 01/2013; 5(1):154-161. DOI:10.1136/heartasia-2013-010328
"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 . In one report, OCT allowed the diagnosis of TCFA with a sensitivity of 90%, and a specificity of 79%, as compared with histopathology . "
[Show abstract][Hide abstract] ABSTRACT: Optical coherence tomography is an exciting light-based imaging modality with a much higher axial resolution as compared with intravascular ultrasound. The diagnostic value of optical coherence tomography resides in its ability to provide information on the stent interaction with the vessel wall at the level of individual struts. Chief clinical implications include evaluating strut neointimal coverage and strut malapposition following coronary stenting. This Editorial covers the basics of optical coherence tomography, its established and potential clinical implications, probable caveats and downsides, in addition to a future perspective, all in view of the late-breaking peer-reviewed literature.
International journal of cardiology 02/2012; 159(2):79-81. DOI:10.1016/j.ijcard.2012.01.070 · 4.04 Impact Factor
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