scholarly journals Elemental Analysis of Soft Plaque and Calcified Plaque Deposits from Human Coronary Arteries and Aorta

2004 ◽  
Vol 39 (6) ◽  
pp. 1487-1496 ◽  
Author(s):  
J. I. Murungi ◽  
S. Thiam ◽  
R. E. Tracy ◽  
J. W. Robinson ◽  
I. M. Warner
Keyword(s):  
Coronary Arteries ◽  
Elemental Analysis ◽  
Calcified Plaque ◽  
Soft Plaque

scholarly journals Focal pericoronary adipose tissue attenuation is related to plaque presence, plaque type, and stenosis severity in coronary CTA

2021 ◽  
Author(s):  
Runlei Ma ◽  
Marly van Assen ◽  
Daan Ties ◽  
Gert Jan Pelgrim ◽  
Randy van Dijk ◽  
...  
Keyword(s):  
Adipose Tissue ◽  
Coronary Arteries ◽  
Plaque Burden ◽  
Severe Stenosis ◽  
Plaque Type ◽  
Plaque Development ◽  
Calcified Plaque ◽  
Stenosis Severity ◽  
Dual Source ◽  
Artery Disease

Abstract Objectives To investigate the association of pericoronary adipose tissue mean attenuation (PCATMA) with coronary artery disease (CAD) characteristics on coronary computed tomography angiography (CCTA). Methods We retrospectively investigated 165 symptomatic patients who underwent third-generation dual-source CCTA at 70kVp: 93 with and 72 without CAD (204 arteries with plaque, 291 without plaque). CCTA was evaluated for presence and characteristics of CAD per artery. PCATMA was measured proximally and across the most severe stenosis. Patient-level, proximal PCATMA was defined as the mean of the proximal PCATMA of the three main coronary arteries. Analyses were performed on patient and vessel level. Results Mean proximal PCATMA was −96.2 ± 7.1 HU and −95.6 ± 7.8HU for patients with and without CAD (p = 0.644). In arteries with plaque, proximal and lesion-specific PCATMA was similar (−96.1 ± 9.6 HU, −95.9 ± 11.2 HU, p = 0.608). Lesion-specific PCATMA of arteries with plaque (−94.7 HU) differed from proximal PCATMA of arteries without plaque (−97.2 HU, p = 0.015). Minimal stenosis showed higher lesion-specific PCATMA (−94.0 HU) than severe stenosis (−98.5 HU, p = 0.030). Lesion-specific PCATMA of non-calcified, mixed, and calcified plaque was −96.5 HU, −94.6 HU, and −89.9 HU (p = 0.004). Vessel-based total plaque, lipid-rich necrotic core, and calcified plaque burden showed a very weak to moderate correlation with proximal PCATMA. Conclusions Lesion-specific PCATMA was higher in arteries with plaque than proximal PCATMA in arteries without plaque. Lesion-specific PCATMA was higher in non-calcified and mixed plaques compared to calcified plaques, and in minimal stenosis compared to severe; proximal PCATMA did not show these relationships. This suggests that lesion-specific PCATMA is related to plaque development and vulnerability. Key Points • In symptomatic patients undergoing CCTA at 70 kVp, PCATMAwas higher in coronary arteries with plaque than those without plaque. • PCATMAwas higher for non-calcified and mixed plaques compared to calcified plaques, and for minimal stenosis compared to severe stenosis. • In contrast to PCATMAmeasurement of the proximal vessels, lesion-specific PCATMAshowed clear relationships with plaque presence and stenosis degree.

Abstract 681: Characteristics of Atherosclerotic Plaque Burden in Patients With and Without Acute Coronary Syndrome Presenting With Acute Chest Pain to the Emergency Department

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Fabian Bamberg ◽  
Maros Ferecik ◽  
Quynh Truong ◽  
Ian Rogers ◽  
Michael Shapiro ◽  
...  
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Coronary Arteries ◽  
Atherosclerotic Plaque ◽  
Acute Chest Pain ◽  
Coronary Plaque ◽  
Plaque Burden ◽  
Coronary Syndrome ◽  
Coronary Ct ◽  
Calcified Plaque

Background: Coronary computed tomography (CT) may improve the early triage of patients with acute chest pain in the emergency department (ED). The aim of this study was to compare the presence and extent of coronary atherosclerotic plaque as detected by coronary CT in patients with and without acute coronary syndromes (ACS). Methods: The study was designed as a prospective, observational cohort study in patients with acute chest pain but negative cardiac biomarkers and no diagnostic ECG changes, admitted to rule out myocardial ischemia. All patients underwent coronary CT prior to hospital admission. The presence of coronary plaque was treated as a dichotomous outcome, and the extent of CAD was defined as number of (1) coronary segments with plaque, or (2) major coronary arteries with plaque detected by MDCT as assessed by two independent observers. The clinical outcome (ACS) was adjudicated by a review committee using established AHA criteria; subjects with history of CAD (stent placement, bypass) were excluded. Results : Among 368 patients with acute chest pain (mean age 53±12 years, 61% male) 31 patients were determined to have ACS (8%). None of the 183 subjects without plaque (50%) had an ACS. Among the remaining 185 subjects (mean age 58.0±11.5 years, 68% male) in whom coronary plaque was detected, patients with ACS had a significantly more plaque (7.2±3.7 vs. 4.2±3.4, p<0.0001 segments) as compared to subjects without ACS. Similar results were seen for calcified plaque and non-calcified plaque (6.5±3.7 vs. 3.6±3.5 segments, p<0.0001; and 3.6±3.2 vs. 1.8±2.2 segments, p<0.0001, respectively). In addition, the rate of ACS increased with the number of major coronary arteries with plaque (1-vessel: 6.8%, 2-vessels: 10.6%, 3 vessels: 30.8%, and 4-vessels: 25%; p<0.01). In contrast, the ratio of non-calcified to calcified plaque was not different between patients with and without ACS (0.68±0.6 vs. 0.54±0.72, p=0.31). Conclusions: The extent of coronary plaque differs between subjects with and without ACS among patients presenting with acute chest pain. Detailed assessment of the extent and composition of coronary plaque may be helpful to assess risk of ACS among patients with acute chest pain but inconclusive initial ED evaluation.

Rotational atherectomy

2010 ◽  
pp. 558-568
Author(s):  
Adam de Belder ◽  
Martyn Thomas
Keyword(s):  
Coronary Arteries ◽  
High Speed ◽  
Bare Metal Stent ◽  
Compressed Air ◽  
Rotational Atherectomy ◽  
Bare Metal ◽  
Stent Deployment ◽  
Calcified Plaque ◽  
Drug Eluting ◽  
Plain Old Balloon Angioplasty

Since 1979, plain old balloon angioplasty (POBA) has provided relief of angina for many patients. Recurrent symptoms due to restenosis diminished with bare-metal stent and, more recently, drug-eluting technology. A limitation to achieving good results with POBA and stenting is calcification within the artery which not only can prevent passage of balloons and stents into a lesion but also may prevent adequate lumen expansion. Rotational atherectomy or rotablation (RA) can treat highly resistant calcified plaque within coronary arteries to allow adequate vessel expansion and ensure optimal stent deployment. The concept of using a high-speed diamond-tipped drill spinning at 150 000rpm driven by compressed air to clear an artery that is 3mm in diameter is challenging, yet this technique has been available for use in coronary arteries since 1989 when M.E. Bertrand (Lille, France) and R. Erbel (Essen, Germany) first used it in humans.

scholarly journals Medical Prior Knowledge Guided Automatic Detection of Coronary Arteries Calcified Plaque with Cardiac CT

Electronics ◽  
2020 ◽  
Vol 9 (12) ◽  
pp. 2122
Author(s):  
Mengxue Zhao ◽  
Xiangjiu Che ◽  
Hualuo Liu ◽  
Quanle Liu
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Object Detection ◽  
Prior Knowledge ◽  
Coronary Arteries ◽  
Cardiac Ct ◽  
Medical Images ◽  
Calcified Plaque ◽  
Artery Disease ◽  
Plaque Detection

Calcified plaque in coronary arteries is one major cause and prediction of future coronary artery disease risk. Therefore, the detection of calcified plaque in coronary arteries is exceptionally significant in clinical for slowing coronary artery disease progression. At present, the Convolutional Neural Network (CNN) is exceedingly popular in natural images’ object detection field. Therefore, CNN in the object detection field of medical images also has a wide range of applications. However, many current calcified plaque detection methods in medical images are based on improving the CNN model algorithm, not on the characteristics of medical images. In response, we propose an automatic calcified plaque detection method in non-contrast-enhanced cardiac CT by adding medical prior knowledge. The training data merging with medical prior knowledge through data augmentation makes the object detection algorithm achieve a better detection result. In terms of algorithm, we employ a deep learning tool knows as Faster R-CNN in our method for locating calcified plaque in coronary arteries. To reduce the generation of redundant anchor boxes, Region Proposal Networks is replaced with guided anchoring. Experimental results show that the proposed method achieved a decent detection performance.

Abstract P335: The Number of Coronary Arteries with Calcified Plaque is Increased in Type 1 Diabetes

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Lindsey M Duca ◽  
Gregory L Kinney ◽  
Amy C Alman ◽  
Janet K Snell-Bergeon
Keyword(s):  
Risk Factors ◽  
Type 1 Diabetes ◽  
Coronary Arteries ◽  
Subclinical Atherosclerosis ◽  
Multivariable Analysis ◽  
Agatston Score ◽  
Cvd Risk ◽  
Calcified Plaque ◽  
Chi Square Analysis

Adults with type 1 diabetes (T1D) have a higher risk for cardiovascular disease than non-diabetic (non-DM) adults. Coronary artery calcification (CAC) is a marker for subclinical atherosclerosis and the Agatston CAC score is the standard used today. The aim of our study was to look at the number of coronary arteries with calcified plaques to determine if more diffuse disease is present in adults with T1D for a given level of CAC. In addition, we examined risk factors associated with the number of coronary arteries with CAC, as this could be a novel way to risk-stratify individuals. This study consisted of 1169 participants (T1D n=535 and non-DM n =634) with a mean ± SD age of 39±9 years. CAC was measured by electron beam CT (EBCT) using two scans performed five minutes apart and the maximum number of coronary arteries with CAC was used in the analysis. CAC lesions were determined in the left main, left anterior descending, circumflex, and right coronary arteries, with a maximum number of arteries with CAC ranging from zero to four. Chi square analysis was used to compare the number of coronary arteries with CAC by diabetes group. Subjects were then divided into categories based on their CAC score (>0-10, 10-100, >100-300, >300) and poisson regression was used in multivariable analysis to examine associated risk factors. Adults with T1D had a significantly higher number of coronary arteries with CAC lesions than the non-DM adults (p > 0.0001). Among subjects with CAC>300 (n=58), adults with T1D had more coronary arteries with CAC than the controls (p = 0.03), but there were no differences in number of arteries with CAC among the other Agatston score categories. In multivariable analysis, HDL and LDL cholesterol, BMI, and hypertension were all independently associated with the number of coronary arteries with CAC lesions when adjusting for age, diabetes and CAC score (p<0.0001). There were no significant associations of number of arteries with CAC with smoking status or hemoglobin A1c. People with T1D were still significantly more likely to have more coronary arteries with CAC lesions than non-DM individuals after adjusting for the above factors. In conclusion, T1D patients have more diffuse subclinical atherosclerosis, as indicated by a greater number of coronary arteries with CAC compared with non-DM adults. The number of coronary arteries with calcified plaque was independently associated with traditional CVD risk factors, even when accounting for CAC score. These findings are important because traditionally just the Agatston CAC score is used to determine CVD risk, but the number of coronary arteries affected could indicate how diffuse the subclinical artherosclerosis is prompt for aggressive treatment of traditional risk factors.

scholarly journals Detection of Symptomatic Carotid Plaque Using Source Data from MR and CT Angiography: A Correlative Study

2015 ◽  
Vol 39 (3-4) ◽  
pp. 151-161 ◽  
Author(s):  
Ajay Gupta ◽  
Hediyeh Baradaran ◽  
Edward E. Mtui ◽  
Hooman Kamel ◽  
Ankur Pandya ◽  
...  
Keyword(s):  
High Risk ◽  
Carotid Artery ◽  
Ct Angiography ◽  
Carotid Plaque ◽  
Source Imaging ◽  
Carotid Artery Plaque ◽  
Symptomatic Disease ◽  
Symptomatic Carotid ◽  
Calcified Plaque ◽  
Soft Plaque

Background: Carotid plaque MRI has been a useful method to characterize vulnerable atherosclerotic plaque elements. Recent investigations have suggested that source images from CT angiography (CTA) and MR angiography (MRA) can identify the simple high-risk features of symptom-producing carotid artery plaque. We studied the correlation and relative diagnostic accuracies of CTA and MRA source images in detecting symptomatic carotid artery plaque. Methods: Subjects were eligible if they had carotid stenosis between 50 and 99% and had MRA and CTA exams performed within 10 days of one another. We measured the soft (non-calcified) plaque and hard (calcified) plaque thickness on CTA axial source images and intraplaque high-intensity signal (IHIS) on 3D-time-of-flight MRA source images in subjects. We assessed whether a correlation existed between increasing CTA soft plaque thicknesses and the presence of MRA IHIS using the Student's t-test. We calculated the differences in sensitivity and specificity measures of CTA and MRA source-imaging data with the occurrence of recent ipsilateral stroke or transient ischemic attack (TIA) as the reference standard. We also performed logistic regression analyses to evaluate the predictive strength of plaque showing both IHIS and increased CTA soft plaque thickness in predicting symptomatic disease status. Results: Of 1994 screened patients, 48 arteries met the final inclusion criteria with MRA and CTA performed within 10 days of one another. The mean and median time between CTA and MRA exams were 2.0 days and 1 day, respectively. A total of 34 of 48 stenotic vessels (70.8%) were responsible for giving rise to ipsilateral stroke or TIA. CTA mean soft plaque thickness was significantly greater (4.47 vs. 2.30 mm, p < 0.0001) in patients with MRA-defined IHIS, while CTA hard plaque thickness was significantly greater (2.09 vs. 1.16 mm, p = 0.0134) in patients without MRA evidence of IHIS. CTA soft plaque thickness measurements were more sensitive than MRA IHIS (91.2 vs. 67.6%, p = 0.011) in detecting symptomatic plaque, while differences in specificity were not significantly different (p = 0.1573). In the subset of patients with both IHIS on MRA and plaque thickness >2.4 mm on CTA, the odds ratio of detecting symptomatic plaque, corrected for stenosis severity, was 45.3 (p < 0.0005). Conclusions: Unprocessed source images from CTA and MRA, which are routinely evaluated for clinical studies demonstrate the highly correlated presence of IHIS and increasing soft plaque thickness. In particular, plaque that shows high-risk features on both MRA and CTA are very strongly associated with symptom-producing carotid plaque. With further validation, such techniques are promising practical methods of extracting risk information from routine neck angiographic imaging.

scholarly journals High-risk plaque burdens myocardial flow reserve in intermediate coronary artery disease: hybrid analysis of 13N-ammonia PET and coronary CT angiography

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Yamamoto ◽  
M Nagao ◽  
K Ando ◽  
R Nakao ◽  
A Sakai ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Arteries ◽  
Coronary Stenosis ◽  
Coronary Ct Angiography ◽  
Coronary Ct ◽  
Flow Reserve ◽  
Calcified Plaque ◽  
Artery Disease ◽  
Myocardial Flow ◽  
Significant Coronary Stenosis

Abstract Background 13N-ammonia PET (NH3-PET) can detect myocardial perfusion abnormalities in patients with coronary artery disease (CAD) and also obtain diagnostic quantitative values of absolute myocardial blood flow and myocardial flow reserve (MFR). Low MFR (MFR&lt;2.0) is an independent prognostic factor for major adverse cardiac event in patients with ischemic and non-ischemic heart disease. A feature of low attenuation plaque (LAP) on coronary CT angiography (CCTA) has been known as high-risk plaque (HRP) for acute coronary syndrome even if there is no significant coronary stenosis. The presence of HRP potentially adversely affects MFR, but the hypothesis has not been elucidated. Purpose We aimed to investigate the affect of LAP to MFR in intermediate CAD. Methods One hundred five patients (age 67±9 years, 65% male) with CAD underwent NH3-PET and CCTA within 6 months between April 2015 and March 2019 were enrolled. Based on the results of CCTA, mild and moderate stenosis were defined as 1% to 49% and 50% to 69% stenosis. Ischemic territories for major three vessels were identified by stress/rest NH3-PET images. Finally, 194 coronary arteries with mild to moderate stenosis corresponding to non-ischemic territory were analyzed in this study. LAP was defined as plaques containing CT value less than 90HU. Partially calcified plaques were included in LAP. Entirely calcification plaque without LAP was defined as calcified plaque. MFR for major three vessels were calculated from dynamic scan at stress/rest NH3-PET. Results CCTA showed 80 coronary arteries with LAP (41%), 104 coronary arteries with calcified plaque (54%), 102 vessels with mild stenosis (53%), and 92 vessels with moderate stenosis (47%). MFRs for coronary arteries with LAP were significantly lower than those without LAP (2.1±0.6 vs 2.5±0.6, p&lt;0.0001). The significant difference in MFR between with and without LAP was observed in both mild and moderate stenosis (mild: 2.0±0.6 vs 2.5±0.6, p=0.0015, moderate: 2.1±0.6 vs 2.5±0.6, p&lt;0.0001). In contrast, coronary arteries with calcified plaque had significantly higher MFR than those without (2.5±0.6 vs 2.1±0.6, p&lt;0.0001). In 58 coronary arteries with MFR&lt;2.0, 71% (41/58) had LAP and 24% (14/58) had calcified plaque. In 136 coronary arteries with MFR≥2.0, 29% (39/136) had LAP and 66% (90/136) had calcified plaque. LAP was significantly more frequent in the former and calcified plaque was significantly more frequent in the latter. Conclusion The presence of LAP burdens MFR in mild to moderate CAD. On the other hand, calcified plaque alone had no adverse effect on MFR. LAP is an important sign in CAD risk assessment even without significant coronary stenosis. MFR and stress MPI Funding Acknowledgement Type of funding source: None

Compositional differences in atherosclerosis between the major epicardial arteries; a secondary analysis from the PARADIGM study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A.M Bax ◽  
X Ma ◽  
I.J Van Den Hoogen ◽  
U Gianni ◽  
A.R Van Rosendael ◽  
...  
Keyword(s):  
Coronary Artery ◽  
High Risk ◽  
Coronary Arteries ◽  
Secondary Analysis ◽  
Hounsfield Unit ◽  
Necrotic Core ◽  
Funding Source ◽  
Circumflex Artery ◽  
Left Circumflex Artery ◽  
Calcified Plaque

Abstract Background Atherosclerotic plaques in the left circumflex artery (LCx) are associated with a lower risk of future events than plaques in the right coronary artery (RCA) and left anterior descending artery (LAD). High risk plaque subtypes including necrotic core and fibrofatty plaque can be evaluated on computed coronary tomography angiography (CCTA) by Hounsfield Unit (HU) density. To date, little is known regarding differences in high risk plaque composition between major epicardial vessels. Purpose The aim of this analysis was to compare plaque extent and composition between the three coronary arteries. Methods This is a secondary analysis of baseline scans from the PARADIGM study which enrolled consecutive patients with suspected coronary artery disease undergoing serial CCTA at a scan interval of ≥2 years. Plaque quantification by composition was performed in the three coronary arteries based on fixed HU thresholds: high risk subtypes consisting of necrotic core (&lt;30 HU) and fibrofatty plaque (31–130 HU), and other subtypes including fibrous (131–350 HU) and calcified plaque (≥351 HU). Comparisons between the coronary arteries were made using Generalized Estimating Equations (GEE) models, accounting for within-patient clustering of the coronary arteries and adjusting for ASCVD risk score and diabetes mellitus. Results From 1,271 patients (mean age 60.3±9.3 years; 57% men; median ASCVD score 9.3%), 3,813 vessels were analyzed. The prevalence of any plaque was lowest in the LCx, as was the prevalence of high risk plaque (Figure; P&lt;0.001 for both). The share of total plaque volume made up by high risk plaque subtypes was the lowest in the LCx (17.3% versus 22.5% [RCA] versus 24.4% [LAD]; P&lt;0.001). In contrast, calcified plaque made up the largest proportion in the LCx (44.5% versus 35.6% [RCA] versus 34.9% [LAD]; P&lt;0.001). Conclusion Prevalence of any plaque as well as high risk plaque subtypes was significantly higher in the LAD and RCA than in the LCx. Also, high risk plaque subtypes made up significantly the lowest proportion in the LCx, whereas calcified plaque made up the largest proportion in the LCx. These data support a different atherogenic milieu contributing to the variable risk patterns between the epicardial coronary arteries. Figure 1. Prevalence of (high risk) plaque Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): This work was supported by the Leading Foreign Research Institute Recruitment Program through the National Research Foundation (NRF) of Korea funded by the Ministry of Science and ICT (MSIT) (Grant no. 2012027176).

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