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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

View larger version (103K): [in a new window]   Figure 1 Angiography shows a right coronary artery with three complex lesions containing ulcerations (A, B, and C); each has a corresponding intravascular ultrasound (IVUS) imaging run. In this figure and in Figure 2, each IVUS imaging run contains multiple image slices that are equidistantly spaced and that were selected to illustrate both the cross-sectional and longitudinal anatomy. The following consistent labeling will be used: double-headed white arrows outline the lipid core/crater with or without hemorrhage, arrow #1 indicates thrombus, arrow #2 indicates the actual rupture site, arrow #3 indicates the residual fibrous cap, and arrow #4 indicates calcium. In lesion A the slices are 0.5 mm apart, in lesion B the slices are 1.5 mm apart, and in lesion C the slices are 1.0 mm apart. Lesion A shows plaque disruption, probable thrombus, and a lipid core/crater; the actual site of rupture and the residual fibrous cap are not clearly evident. Lesion B shows all of the elements: lipid core/crater (double-headed arrow), site of rupture with residual fibrous cap (arrow #2), and thrombus (arrow #1). The rupture appeared to have occurred in the center of the fibrous cap. Lesion C shows a lipid core/crater (double-headed arrow), site of rupture, and residual fibrous cap (arrow #2), but no thrombus. The rupture appeared to have occurred at the shoulder of the fibrous cap.

View larger version (67K): [in a new window]   Figure 2 Angiography shows a right coronary artery with an aneurysm. Intravascular ultrasound revealed a plaque rupture with a lipid core/crater(double-headed arrow), site of rupture (arrow #2), and thrombus (arrow #1), but no residual fibrous cap. Image slices are 1.5 mm apart.

View larger version (21K): [in a new window]   Figure 3 A flow chart of the intravascular ultrasound (IVUS) and angiographic analyses shows the relationship between multiple plaque ruptures detected by the two techniques.

View larger version (13K): [in a new window]   Figure 4 This histogram shows the distribution of lumen CSA at rupture and MLA sites. The lumen CSA at rupture sites varied widely and was larger than at the MLA site. CSA = cross-sectional area; MLA = minimum lumen CSA.