scholarly journals Non-lipid-rich low attenuation plaque with intraplaque haemorrhage assessed by multimodality imaging: a case report

2021 ◽  
Author(s):  
Hidenari Matsumoto ◽  
Yibin Xie ◽  
Debiao Li ◽  
Toshiro Shinke
Keyword(s):  
Coronary Artery ◽  
Near Infrared ◽  
Multimodality Imaging ◽  
Necrotic Core ◽  
Hounsfield Units ◽  
Plaque Instability ◽  
Coronary Syndrome ◽  
Intraplaque Haemorrhage ◽  
Magnetic Resonance Imaging Mri ◽  
Low Attenuation Plaque

Abstract Background The lipid-rich necrotic core is a major pathological hallmark of acute coronary syndrome. Low attenuation plaque (LAP) on coronary computed tomography angiography (CCTA), defined as plaque CT attenuation of <30 Hounsfield units, is commonly believed to correspond to the lipid component. This report presents a non-lipid-rich LAP with intraplaque haemorrhage of the left main coronary artery (LM), as assessed by CCTA, near-infrared spectroscopy (NIRS), and non-contrast magnetic resonance imaging (MRI) using coronary atherosclerosis T1-weighted characterisation with integrated anatomical reference technique, recently developed by our group. Case Summary A 75-year-old woman presented with chest discomfort on exertion. CCTA revealed severe stenosis of the mid-left circumflex coronary artery and minimal stenosis with a large eccentric LM plaque. The LM lesion had an LAP, with a minimum plaque attenuation of 25 Hounsfield units. On non-contrast T1-weighted MRI, a high-intensity plaque with a plaque-to-myocardium signal intensity ratio of 3.02 was observed within the vessel wall, indicating intraplaque haemorrhage. NIRS categorised the lesion as non-lipid-rich, with a maximum lipid core burden index in 4 mm of 169. Discussion Intraplaque haemorrhage is a key feature of plaque instability, which is different from the lipid-rich necrotic core. Non-contrast T1-weighted MRI is ideal for detecting intraplaque haemorrhage with short T1 values. The imaging findings suggest that LAP on CCTA may represent not only lipid-rich plaques but also intraplaque haemorrhage. MRI provides a unique insight into plaque vulnerability from a different perspective than lipid assessment. Multimodality imaging, including MRI, facilitates the understanding complicated plaque morphologies.

scholarly journals New Imaging Methods of Coronary Arteries in Acute Coronary Syndromes

2015 ◽  
Vol 1 (2) ◽  
pp. 56-64
Author(s):  
Ota Hlinomaz ◽  
Ladislav Groch ◽  
Jan Sitar ◽  
Michal Rezek ◽  
Jiří Seménka ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Arteries ◽  
Near Infrared ◽  
Interventional Cardiology ◽  
Lipid Core ◽  
Plaque Instability ◽  
Vein Grafts ◽  
Coronary Syndrome ◽  
Coronary Wall ◽  
Artery Disease

Abstract Coronary angiography is still the most widely used method for the assessment of lumen of coronary arteries and for diagnosis and treatment of coronary artery disease. New imaging modalities of coronary arteries play an increasing role in interventional cardiology. Intravascular ultrasound (IVUS) is the oldest technology, however due to its high tissue penetration remains very important for imaging of left main coronary artery and saphenous vein grafts. IVUS was used in many clinical trials and clinical experience with it is huge. Optical coherence tomography (OCT) is a new, very fast developing method. It has ten times higher axial resolution than IVUS. It gives us the opportunity to assess the inner structures of coronary artery wall, to evaluate the characteristics of atherosclerotic plaques, quality of stent implantation and its healing. It helps us to find the culprit lesion of acute coronary syndrome in some cases, to diagnose the cause of stent thrombosis, and to evaluate stent apposition which has a direct relation to prognosis. We use it to perform complex percutaneous coronary interventions and after heart transplantation to diagnose the vascular graft disease. We strongly believe that OCT is important for the assessment of plaque instability and patient´s prognosis. Near infrared spectroscopy combined with IVUS can distinguish fibrous from lipid core plaques. Lipid core burden index is in relation to a risk of periprocedural myocardial infarction and to prognosis. It is the only method which can sufficiently detect the amount of lipids in coronary wall.

Abstract 4008: PSGL-1-Expressing CD4 T Cells are Enriched in Culprit Coronary Artery Lesion of Acute Coronary Syndrome

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Keiko Gomita ◽  
Kayoko Sato ◽  
Kazutaka Kitamura ◽  
Nobuhisa Hagiwara
Keyword(s):  
T Cells ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Adhesion Molecules ◽  
Peripheral Blood ◽  
Cd4 T Cells ◽  
Coronary Artery Lesion ◽  
Plaque Instability ◽  
Coronary Syndrome

Background: Recently, several evidences on the crucial role of adhesion molecules in the development of atherosclerosis and plaque instability have been reported. While expression of VCAM-1, ICAM-1 and L-selectin has been consistently observed in atherosclerotic plaques it is still uncertain how adhesion molecules on T cells contribute to the incidence of acute coronary syndrome (ACS). In this study, we examined whether adhesion molecules on T cells in ACS have a significant role in the plaque stability and prone to cause ACS. Methods and Results: Fresh CD4 T cells were isolated from the peripheral blood of 76 ACS patients (AMI=35, UAP=41) and 74 age-matched controls (NC). CD69, an activation marker of T cells, was strongly expressed on CD4 T cells from ACS than from NC by FACS (P<0.0001). CD4 T cells from ACS highly expressed p-selectin glycoprotein ligand-1 (PSGL-1) and integrin β (CD18), but not L-selectin by FACS (P < 0.03, P < 0.01, n.s., respectively). Soluble PSGL-1 (sPSGL-1) levels in plasma were lower in ACS patients than in NC (P=0.0001), which correlated negatively with the PSGL-1 expression on CD4 T cells (R=0.405, P<0.02). We further investigated the thrombus-aspirating device samples (n=14) and fresh CD4 T cells derived from both the coronary artery and peripheral blood from the each same patient with ACS. CD4 T cells from the coronary artery strongly expressed PSGL-1 (P<0.002), but not integrin β (CD18) and L-selectin by FACS. Finally, PSGL-1 was expressed on T cells, but not on CD68 positive macrophage, MPO positive neutrophil, or CD41 positive platelets in the thrombus-aspirating device samples. Conclusions: From these results, we demonstrated that PSGL-1-expressing CD4 T cells are enriched in the culprit coronary artery lesion of ACS, contributing to the acceleration of plaque instability and occurrence of ACS.

A Novel Cause of Acute Coronary Syndrome Due to Dynamic Extrinsic Coronary Artery Compression by a Rib Exostosis: Multimodality Imaging Diagnosis

2015 ◽  
Vol 31 (10) ◽  
pp. 1303.e9-1303.e11 ◽  
Author(s):  
Jonathan C.L. Rodrigues ◽  
Helen C. Mathias ◽  
Stephen M. Lyen ◽  
Elisa Mcalindon ◽  
Chiara Bucciarelli-Ducci ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Multimodality Imaging ◽  
Imaging Diagnosis ◽  
Coronary Syndrome

In vivo relationship between near-infrared spectroscopy-detected lipid-rich plaques and morphological plaque characteristics by optical coherence tomography and intravascular ultrasound: a multimodality intravascular imaging study

2020 ◽  
Author(s):  
Christian Zanchin ◽  
Yasushi Ueki ◽  
Sylvain Losdat ◽  
Gregor Fahrni ◽  
Joost Daemen ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Infrared Spectroscopy ◽  
Intravascular Ultrasound ◽  
Near Infrared Spectroscopy ◽  
Near Infrared ◽  
Multimodality Imaging ◽  
Plaque Burden ◽  
Optical Coherence ◽  
Coronary Syndrome ◽  
Automated Method

Abstract Aims We assessed morphological features of near-infrared spectroscopy (NIRS)-detected lipid-rich plaques (LRPs) by using optical coherence tomography (OCT) and intravascular ultrasound (IVUS). Methods and results IVUS-NIRS and OCT were performed in the two non-infarct-related arteries (non-IRAs) in patients undergoing percutaneous coronary intervention for treatment of an acute coronary syndrome. A lesion was defined as the 4 mm segment with the maximum amount of lipid core burden index (maxLCBI4mm) of each LRP detected by NIRS. We divided the lesions into three groups based on the maxLCBI4mm value: &lt;250, 250–399, and ≥400. OCT analysis and IVUS analysis were performed blinded for NIRS. We measured fibrous cap thickness (FCT) by using a semi-automated method. A total of 104 patients underwent multimodality imaging of 209 non-IRAs. NIRS detected 299 LRPs. Of those, 41% showed a maxLCBI4mm &lt;250, 39% a maxLCBI4mm 251–399, and 19% a maxLCBI4mm ≥400. LRPs with a maxLCBI4mm ≥400, as compared with LRPs with a maxLCBI4mm 250–399 and &lt;250, were more frequently thin-cap fibroatheroma (TCFA) (42.1% vs. 5.1% and 0.8%; P &lt; 0.001) with a smaller minimum FCT (80 μm vs. 110 μm and 120 μm; P &lt; 0.001); a higher IVUS-derived percent atheroma volume (53% vs. 53% and 44%; P &lt; 0.001) and a higher remodelling index (1.08 vs. 1.02 and 1.01; P &lt; 0.001). MaxLCBI4mm correlated with OCT-derived FCT (r = 0.404; P &lt; 0.001) and was the best predictor for TCFA with an optimal cut-off value of 401 (area under the curve = 0.882; P &lt; 0.001). Conclusion LRPs with increasing maxLCBI4mm exhibit OCT and IVUS features of presumed plaque vulnerability including TCFA morphology, increased plaque burden, and positive remodelling.

scholarly journals Case Report: Multimodality Imaging as a Lifeline for Fatal Localization of Valsalva Sinus Fibroelastoma

2021 ◽  
Vol 8 ◽  
Author(s):  
Snezana Tadic ◽  
Aleksandra Ilic ◽  
Maja Stefanovic ◽  
Anastazija Stojsic-Milosavljevic ◽  
Tanja Popov ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Cardiac Surgery ◽  
Coronary Artery ◽  
Left Main Coronary Artery ◽  
Multimodality Imaging ◽  
Fatal Outcome ◽  
Invasive Procedure ◽  
Imaging Method ◽  
Left Main ◽  
Coronary Syndrome

Background: Papillary fibroelastomas are rare benign heart tumors, and is most likely to involve the cardiac valves. We will present an extremely rare localization of a large Valsalva sinus fibroelastoma, with occasional left coronary artery ostial obstruction presented as an acute coronary syndrome. The tumor was removed surgically and histologically confirmed as papillary fibroelastoma. This review points to the crucial importance of multidisciplinary team decision and multimodality imaging methods for diagnosing the fibroelastoma, determination of size, and localization, which avoided complications of fatal embolization during an invasive procedure.Case Summary: A healthy 55-year-old male with vigorous physical daily training and exercise was admitted to the acute coronary syndrome emergency department. Shortly after admission, expert transthoracic echocardiography was performed. Computed tomography of the chest observed a large irregular hypodense tumor-like lesion in the bulbar aorta that was occasionally prolapsing into the left main coronary artery ostium and which corresponded to fibroelastoma. A few hours after admission, an emergency cardiac surgery was performed with the excision of a Valsalva sinus tumor (size 2 × 2 cm) located between the right and left coronary cusp of the aortic valve.Conclusions: Focus cardiac ultrasound should be performed for any acute coronary syndrome because of the possible Valsalva sinus fibroelastoma etiology. Its localization next to the left main coronary artery ostium is rare, and dangerous. The timely diagnosis can be made by the multimodality imaging method, however, the final diagnosis will be made pathohistologically. Early cardiac surgery may be a necessitated recourse for these patients in order to prevent a fatal outcome.

Pathology of stable coronary artery disease

ESC CardioMed ◽  
2018 ◽  
pp. 1315-1320
Author(s):  
Michael Joner ◽  
Maria Isabel Castellanos ◽  
Anna Bulin ◽  
Kristin Steigerwald
Keyword(s):  
Coronary Artery Disease ◽  
Smooth Muscle ◽  
Coronary Artery ◽  
Smooth Muscle Cells ◽  
Muscle Cells ◽  
Necrotic Core ◽  
Intimal Thickening ◽  
Intraplaque Haemorrhage ◽  
Artery Disease ◽  
Plaque Destabilization

Coronary artery disease remains the major cause of morbidity and mortality on a global scale. Intimal thickening and fatty streaks represent early adaptive vascular changes, which are often regressive. Pathological intimal thickening represents the earliest progressive atherosclerotic lesion characterized by a focal accumulation of smooth muscle cells and acellular areas, often associated with lipid pools. Fibroatheroma is characterized by a necrotic core and can be split into early and late fibroatheroma, where macrophage apoptosis and defective efferocytosis play important roles in lesion progression. Intraplaque hypoxia is believed to result in neovascularization with subsequent intraplaque haemorrhage because of immature and leaky microvessels. Due to excessive cholesterol in remnants of erythrocyte membranes, intraplaque haemorrhage may result in rapid progression of necrotic core and plaque destabilization. Healed plaque rupture has been well delineated as an important mechanism of gradual luminal narrowing, where changes in collagen deposition allow recognition of rupture and healing sites. Calcification results from apoptosis of smooth muscle cells and macrophages or may also be caused by active release of cellular vesicles involved in calcium haemostasis. Extracellular matrix changes are associated with progression of atherosclerosis, while integrin signalling has been recognized as an important outside-in transcellular target of the inflammatory response.

scholarly journals Circulating Biomarkers Reflecting Destabilization Mechanisms of Coronary Artery Plaques: Are We Looking for the Impossible?

Biomolecules ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 881
Author(s):  
Marko Kumric ◽  
Josip A. Borovac ◽  
Dinko Martinovic ◽  
Tina Ticinovic Kurir ◽  
Josko Bozic
Keyword(s):  
Coronary Artery ◽  
Vulnerable Plaque ◽  
Cost Effective ◽  
Current Evidence ◽  
Plaque Instability ◽  
Coronary Syndrome ◽  
Non Invasive ◽  
Multiple Biomarkers ◽  
Plaque Destabilization

Despite significant strides to mitigate the complications of acute coronary syndrome (ACS), this clinical entity still represents a major global health burden. It has so far been well-established that most of the plaques leading to ACS are not a result of gradual narrowing of the vessel lumen, but rather a result of sudden disruption of vulnerable atherosclerotic plaques. As most of the developed imaging modalities for vulnerable plaque detection are invasive, multiple biomarkers were proposed to identify their presence. Owing to the pivotal role of lipids and inflammation in the pathophysiology of atherosclerosis, most of the biomarkers originated from one of those processes, whereas recent advancements in molecular sciences shed light on the use of microRNAs. Yet, at present there are no clinically implemented biomarkers or any other method for that matter that could non-invasively, yet reliably, diagnose the vulnerable plaque. Hence, in this review we summarized the available knowledge regarding the pathophysiology of plaque instability, the current evidence on potential biomarkers associated with plaque destabilization and finally, we discussed if search for biomarkers could one day bring us to non-invasive, cost-effective, yet valid way of diagnosing the vulnerable, rupture-prone coronary artery plaques.

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