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CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

The Relationship Between Coronary Plaque Characteristics and Small Embolic Particles During Coronary Stent Implantation

Takahiro Kawamoto, MD, PhD^_*,_*, Hiroyuki Okura, MD, PhD^_*, Yuji Koyama, MD, PhD^_*, Iku Toda, MD, PhD, Haruyuki Taguchi, MD, PhD, Koichi Tamita, MD, Atsushi Yamamuro, MD, Yuki Yoshimura, MD^_*, Yoji Neishi, MD, PhD^_*, Eiji Toyota, MD, PhD^_* and Kiyoshi Yoshida, MD, PhD, FACC^_*

^_* Division of Cardiology, Kawasaki Medical School Hospital, Kurashiki, Japan
Division of Cardiology, Bell Land General Hospital, Sakai, Japan
Division of Cardiology, Kobe General Hospital, Kobe, Japan

Manuscript received February 21, 2007; revised manuscript received May 16, 2007, accepted May 21, 2007.

^_* Reprint requests and correspondence: Dr. Hiroyuki Okura, The Division of Cardiology, Kawasaki Medical School Hospital, 577, Matsushima, Kurashiki, Japan. (Email: hokura{at}fides.dti.ne.jp).

Objectives: We investigated the relationship between coronary plaque components and small embolic particles during stenting and examined the influence on the coronary microcirculation.

Background: In vivo tissue characterization of atherosclerotic plaques was introduced by the Virtual Histology intravascular ultrasound (VH-IVUS) system (Volcano Therapeutics, Inc., Rancho Cordova, California).

Methods: The study consisted of 44 patients who underwent elective coronary stenting. Plaque characteristics were identified with VH-IVUS, and small embolic particles liberated during stenting were detected as high-intensity transient signals (HITS) with a Doppler guidewire. Coronary flow velocity reserve (CFVR) was also measured before and after stenting.

Results: Patients were divided into the tertiles according to the HITS counts: the lowest, HITS <5 (n = 16); the middle, 5 to 12 (n = 15); and the highest, >12 (n = 13). Dense calcium and necrotic core area identified with VH-IVUS were significantly larger in the highest tertile (lowest vs. middle vs. highest; dense calcium: 0.2 ± 0.3 mm² vs. 0.3 ± 0.6 mm² vs. 0.8 ± 0.7 mm², p = 0.007; necrotic core: 0.5 ± 0.4 mm² vs. 0.9 ± 0.9 mm² vs. 1.8 ± 1.0 mm², p < 0.001, respectively). Multivariate logistic regression analysis revealed only necrotic core area was an independent predictor of high HITS counts (odds ratio 4.41, p = 0.045). Furthermore, there was a significant negative correlation between the HITS count and CFVR after stenting (r = –0.35, p = 0.017).

Conclusions: The necrotic core component identified with VH-IVUS is related to liberation of small embolic particles during coronary stenting, which results in the poorer recovery of CFVR.

Abbreviations and Acronyms   AMI = acute myocardial infarction   CFVR = coronary flow velocity reserve   CSA = cross-sectional area   EEM = external elastic membrane   HITS = high-intensity transient signals   IVUS = intravascular ultrasound   P+M = plaque plus media   PCI = percutaneous coronary intervention   VH = Virtual Histology

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