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CLINICAL STUDY

Mechanical and structural characteristics of vulnerable plaques: analysis by coronary angioscopy and intravascular ultrasound

^a Department of Internal Medicine, Nippon Medical School, Chiba Hokusoh Hospital, Chiba, Japan

Manuscript received November 20, 2000; revised manuscript received March 13, 2001, accepted March 26, 2001.

Reprint requests and correspondence: Dr. Kyoichi Mizuno, Department of Internal Medicine, Nippon Medical School, Chiba Hokusoh Hospital, 1715 Kamakari, Imba, Imba, Chiba, Japan
mizunok{at}nms.ac.jp

OBJECTIVES

Mechanical and structural characteristics of vulnerable plaques were evaluated using coronary angioscopy and intravascular ultrasound.

BACKGROUND

Mechanical stress and composition of plaques play an important role in plaque disruption.

METHODS

Thirty-eight lesions in 38 patients were examined pre-interventionally. The plaques were classified as either yellow or white using coronary angioscopy. Intravascular ultrasound imaging was performed simultaneously with electrocardiographic and intracoronary pressure recordings to calculate distensibility index and stiffness ß. Moreover, the type of remodeling was classified.

RESULTS

We identified 27 patients with yellow plaques and 11 patients with white plaques. Patients with yellow plaques presented acute coronary syndromes more frequently than stable angina (85% vs. 36%, p < 0.01). The distensibility index in yellow plaques was significantly greater than it was in white plaques (2.7 ± 0.8 mm Hg^–1 vs. 0.7 ± 0.8 mm Hg^–1, p < 0.0001), while stiffness ß for white plaques was significantly greater than it was for yellow plaques (34.9 ± 16.3 vs. 8.7 ± 2.7, p < 0.0001). Compensatory enlargement occurred more frequently with yellow plaques than with white plaques (56% vs. 9%, p < 0.01), while paradoxical shrinkage occurred more frequently with white plaques than it did with yellow plaques (64% vs. 4%, p < 0.001).

CONCLUSIONS

Yellow plaques with an increased distensibility and a compensatory enlargement may be mechanically and structurally weak. As a result, mechanical "fatigue," caused by repetitive stretching, may lead to plaque disruption. Plaques with a high distensibility and a compensatory enlargement may be vulnerable.

Abbreviations and Acronyms   CSA = cross-sectional area   DBP = diastolic intracoronary pressure   EEM = external elastic membrane   IVUS = intravascular ultrasound   RR = remodeling ratio   SBP = systolic intracoronary pressure

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