Mechanical and structural characteristics of vulnerable plaques: analysis by coronary angioscopy and intravascular ultrasound
Masamichi Takano, MDa,
Kyoichi Mizuno, MD, FACCa,
Kentaro Okamatsu, MDa,
Shinya Yokoyama, MDa,
Takayoshi Ohba, MDa and
Shunta Sakai, MDa
a Department of Internal Medicine, Nippon Medical School, Chiba Hokusoh Hospital, Chiba, Japan
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Figure 1 (A) Angioscopic image of the left anterior descending artery in a patient with acute myocardial infarction demonstrating yellow plaque. (B,C,D) Intravascular ultrasound images at the same lesion as A demonstrating compensatory enlargement. (B) At the proximal reference site, external elastic membrane (EEM) cross-sectional area (CSA) was 11.8 mm2. (C) At the culprit lesion, EEM CSA was 13.5 mm2. (D) At the distal reference site, EEM CSA was 9.6 mm2. The remodeling ratio (RR) was 1.26. (E) Angioscopic image of the left anterior descending artery in a patient with stable angina demonstrating white plaque. (F,G,H) Intravascular ultrasound images at the same lesion as E demonstrating paradoxical shrinkage. (F) At the proximal reference site, EEM CSA was 17.1 mm2. (G) At the culprit lesion, EEM CSA was 10.1 mm2. (H) At the distal reference site, EEM CSA was 15.3 mm2. The RR was 0.62.
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Figure 2 Intravascular ultrasound images of changes in the lumen cross-sectional area (CSA). (Left) Lumen CSA was 2.7 mm2 during diastole. (Right) Lumen CSA increased to 3.5 mm2 during systole.
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Figure 3 Correlations between percentage of plaque area and stiffness ß. Open squares represent white plaques, and open circles represent yellow plaques. Good correlation is observed (white plaques: r2 = 0.432, p = 0.0279; yellow plaques: r2 = 0.325, p = 0.0019). The stiffness ß for the white plaques is significantly greater than for the yellow plaques (p = 0.00391).
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