CLINICAL STUDY: ULTRASOUND CORONARY IMAGING
Morphologic and angiographic features of coronary plaque rupture detected by intravascular ultrasound
Akiko Maehara, MD*,
Gary S. Mintz, MD, FACC ,
Anh B. Bui, MD*,
Olga R. Walter, RN*,
Marco T. Castagna, MD*,
Daniel Canos, MPH*,
August D. Pichard, MD, FACC*,
Lowell F. Satler, MD, FACC*,
Ron Waksman, MD, FACC*,
William O. Suddath, MD, FACC*,
John R. Laird, Jr, MD, FACC*,
Kenneth M. Kent, MD, PhD, FACC* and
Neil J. Weissman, MD, FACC*,*
* Cardiovascular Research Institute, Washington Hospital Center, Washington, DC, USA
Cardiovascular Research Foundation, New York, New York, USA
Manuscript received December 19, 2001;
revised manuscript received May 2, 2002,
accepted May 24, 2002.
* Reprint requests and correspondence: Dr. Neil J. Weissman, Cardiovascular Research Institute, 110 Irving St, NW Suite 4B-1, Washington, DC 20010, USA
Neil.J.Weissman{at}medstar.net
OBJECTIVES: This study was designed to report the clinical and angiographic correlates of plaque rupture detected by intravascular ultrasound (IVUS).
BACKGROUND: Acute coronary syndromes result from spontaneous plaque rupture and thrombosis.
METHODS: We report 300 plaque ruptures in 257 arteries in 254 patients. Plaque ruptures were detected during pre-intervention IVUS. Standard clinical, angiographic, and IVUS parameters were collected and/or measured. One lesion per patient was analyzed.
RESULTS: Multiple ruptures were observed in 39 of 254 patients (15%), 36 in the same artery. Plaque rupture occurred not only in patients with unstable angina (46%) or myocardial infarction (MI, 33%), but also stable angina (11%) or no symptoms (11%). The tear in the fibrous cap could be identified in 157 of 254 patients; 63% occurred at the shoulder of the plaque and 37% in the center of the plaque. Thrombi were more common in patients with unstable angina or MI (p = 0.02) and in multiple ruptures (p = 0.04). The plaque rupture site contained the minimum lumen area (MLA) site in only 28% of patients; rupture sites had larger arterial and lumen areas and more positive remodeling than MLA sites. Intravascular ultrasound plaque rupture strongly correlated with complex angiographic lesion morphology: ulceration in 81%, intimal flap in 40%, thrombus in 7%, and aneurysm in 7%.
CONCLUSIONS: Plaque ruptures occur with varying clinical presentations, strongly correlate with angiographic complex lesion morphology, may be multiple, and usually do not cause lumen compromise.
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Abbreviations and Acronyms
| | CABG | | coronary artery bypass grafting | | CSA | | cross-sectional area | | EEM | | external elastic membrane | | IVUS | | intravascular ultrasound | | MI | | myocardial infarction | | MLA | | minimum lumen area | | PCI | | percutaneous coronary intervention |
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