scholarly journals Cholesterol-crystalized coronary atheroma as a potential precursor lesion causing acute coronary syndrome: a case report

2019 ◽  
Vol 3 (3) ◽  
Author(s):  
Hiroki Sugane ◽  
Yu Kataoka ◽  
Fumiyuki Otsuka ◽  
Satoshi Yasuda
Keyword(s):  
Optical Coherence Tomography ◽  
Acute Coronary Syndrome ◽  
Coronary Angiography ◽  
Atherosclerotic Plaques ◽  
Culprit Lesion ◽  
Cholesterol Crystals ◽  
Coronary Syndrome ◽  
Obstructive Lesion ◽  
Coronary Events ◽  
Potential Precursor

Abstract Background Histopathological studies have reported the presence of cholesterol crystals in the culprit lesion in patients with sudden cardiac death. Given that cholesterol crystals themselves promote pro-inflammatory cascades, they may destabilize atherosclerotic plaques, leading to the occurrence of acute coronary events. Case summary A 60-year-old man presented with ST-segment elevation myocardial infarction. Emergent coronary angiography revealed a severely stenotic lesion (=culprit lesion) and another non-obstructive lesion in the proximal and middle segments of the left anterior descending artery (LAD), respectively. Optical coherence tomography (OCT) imaging showed that both lesions exhibited lipid-rich plaque with cholesterol crystals, and the non-obstructive lesion in the mid-LAD did not have a thin fibrous cap (its thickness = 230 μm). A drug-eluting stent was successfully implanted at the culprit lesion in the proximal LAD. On non-contrast T1-weighted magnetic resonance imaging performed 10 days after percutaneous coronary intervention (PCI), a high-intensity signal was identified at the non-obstructive mid-LAD lesion. This lesion was medically managed with aspirin, clopidogrel, and rosuvastatin due to the absence of myocardial ischaemia. However, 12 months after PCI, the patient was hospitalized again due to unstable angina pectoris. Coronary angiography revealed substantial progression of the mid-LAD lesion. Optical coherence tomography imaging prior to the second PCI showed a severely narrowed lesion containing cholesterol crystals and covered by organized thrombus. This lesion harbored an extensive amount of lipidic materials on near-infrared spectroscopy (maximum 4-mm lipid core burden index = 809). Discussion In our case, atherosclerotic plaques containing cholesterol crystals was associated with the occurrence of acute coronary syndrome. Our findings suggest that plaque with cholesterol crystals is a potential precursor to future acute coronary events.

Impact of Accumulated Serum Uric Acid on Coronary Culprit Lesion Morphology Determined by Optical Coherence Tomography and Cardiac Outcomes in Patients with Acute Coronary Syndrome

Cardiology ◽  
2018 ◽  
Vol 141 (4) ◽  
pp. 190-198 ◽  
Author(s):  
Nobuaki Kobayashi ◽  
Kuniya Asai ◽  
Masafumi Tsurumi ◽  
Yusaku Shibata ◽  
Hirotake Okazaki ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Acute Coronary Syndrome ◽  
Uric Acid ◽  
Serum Uric Acid ◽  
Plaque Morphology ◽  
Optical Coherence ◽  
Cardiac Mortality ◽  
Culprit Lesion ◽  
Coronary Syndrome ◽  
Very High

Objectives: We aimed to examine the relations of very high levels of serum uric acid (sUA) with features of culprit lesion plaque morphology determined by optical coherence tomography (OCT) and adverse clinical outcomes in patients with acute coronary syndrome (ACS). Methods: We retrospectively compared ACS patients according to sUA levels of > 8.0 mg/dL (n = 169), 7.1–8.0 mg/dL (n = 163), 6.1–7.0 mg/dL (n = 259), and ≤6.0 mg/dL (n = 717). Angiography and OCT findings were analyzed in patients with preintervention OCT and the 4 sUA groups (> 8.0 mg/dL, n = 61; 7.1–8.0 mg/dL, n = 72; 6.1–7.0 mg/dL, n = 131; and ≤6.0 mg/dL, n = 348) were compared. Results: Cardiogenic shock was more prevalent in ACS patients with sUA > 8.0 mg/dL (22% vs. 19% vs. 10% vs. 6%, p < 0.001). Plaque rupture was observed more prevalently by OCT in patients with sUA > 8.0 mg/dL (67% vs. 47% vs. 56% vs. 45%, p = 0.027). At the 2-year follow-up, Kaplan-Meier estimates showed higher cardiac mortality in patients with sUA > 8.0 mg/dL (25% vs. 12% vs. 5% vs. 5%, p < 0.001). After adjusting for traditional cardiovascular risk factors and creatinine levels, patients with sUA > 8.0 mg/dL showed a 4.5-fold increased risk in 2-year cardiac death by multivariate Cox proportional hazard analysis (hazard ratio 4.54, 95% confidence interval 2.98–6.91; p < 0.001). Conclusions: Very high sUA levels like > 8.0 mg/dL are the primary predictor of 2-year cardiac mortality and could partly be caused by adverse effects of accumulated sUA on plaque morphology in patients with ACS.

scholarly journals Gender-based in-vivo comparison of culprit plaque characteristics and plaque microstructures using optical coherence tomography in acute coronary syndrome

2021 ◽  
Author(s):  
Krishna Prasad ◽  
Sreeniavs Reddy S ◽  
Jaspreet Kaur ◽  
Raghavendra Rao k ◽  
Suraj Kumar ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Acute Coronary Syndrome ◽  
Plaque Rupture ◽  
Plaque Morphology ◽  
Optical Coherence ◽  
Cholesterol Crystals ◽  
Coronary Syndrome ◽  
Significant Difference ◽  
Gender Based

Introduction: Women perform worse after acute coronary syndrome (ACS) than men. The reason for these differences is unclear. The aim was to ascertain gender differences in the culprit plaque characteristics in ACS. Methods:Patients with ACS undergoing percutaneous coronary intervention for the culprit vessel underwent optical coherence tomography (OCT) imaging. Culprit plaque was identified as lipid rich,fibrous, and calcific plaque. Mechanisms underlying ACS are classified as plaque rupture, erosion,or calcified nodule. A lipid rich plaque along with thin-cap fibroatheroma (TCFA) was a vulnerable plaque. Plaque microstructures including cholesterol crystals, macrophages, and microvessels were noted. Results: A total of 52 patients were enrolled (men=29 and women=23). Baseline demographic features were similar in both the groups except men largely were current smokers (P<0.001). Plaque morphology,men vs. women: lipid rich 88.0% vs. 90.5%; fibrous 4% vs 0%; calcific 8.0% vs. 9.5% (P = 0.64). Of the ACS mechanisms in males versus females; plaque rupture (76.9 % vs. 50 %), plaque erosion (15.4 % vs.40 %) and calcified nodule (7.7 % vs. 10 %) was noted (P = 0.139). Fibrous cap thickness was (50.19 ±11.17 vs. 49.00 ± 10.71 mm, P = 0.71) and thin-cap fibroatheroma (96.2% vs. 95.0%, P = 1.0) in men and women respectively. Likewise no significant difference in presence of macrophages (42.3 % vs. 30%, P = 0.76), microvessels (73.1% vs. 60 %, P = 0.52) and cholesterol crystals (92.3% vs. 80%, P = 0.38). Conclusion: No significant gender-based in-vivo differences could be discerned in ACS patients’ culprit plaques morphology, characteristics, and underlying mechanisms.

scholarly journals Assessment of atherosclerotic plaques morphology and composition by computed tomography coronary angiography: comparison in patients with acute coronary syndrome and stable angina

2020 ◽  
pp. 48-56
Author(s):  
Н.А. Барышева ◽  
И.Н. Меркулова ◽  
М.А. Шария ◽  
М.С. Шабанова ◽  
Т.Н. Веселова ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Acute Coronary Syndrome ◽  
Coronary Angiography ◽  
Stable Angina ◽  
Multislice Ct ◽  
Structural Features ◽  
Atherosclerotic Plaques ◽  
Coronary Syndrome ◽  
Remodeling Index ◽  
Low X

Цель исследования. Сравнение особенностей строения атеросклеротических бляшек (АСБ) в коронарных артериях (КА) у больных с острым коронарным синдромом (ОКС) и стабильной стенокардией (СС). По данным компьютерной томографии (КТ). Материал и методы. Исследование выполнено у 125 больных: с ОКС (n = 94) и СС (n = 31). КТ КА с использованием томографа с 64 рядами де- текторов проводилась до стентирования КА. Определялись тип, протяженность, бремя АСБ, индекс ремоделирования (ИР), а также признаки нестабильности АСБ: наличие точечных кальцинатов, положительное ремоделирование артерии, неровность контура, наличие кольцевидного усиления плотности по периферии АСБ и участка низкой рентгеновской плотности <46 HU. Результаты. В группе больных с ОКС (n = 250 АСБ) по сравнению со СС (n = 81 АСБ) достоверно чаще определялись мягкие бляшки и до- стоверно реже — кальцинированные: n = 127 (50,8%) и n = 26 (32,1%), p = 0,0046; n = 24 (9,6%) и n = 25 (30,9%), p = 0,0011. При срав- нении совокупности мягких и комбинированных АСБ группы ОКС (n=226) и СС (n=56) в группе с ОКС значение ИР было значимо выше (1,20 [1,14; 1,32] и 1,13 [1,05; 1,25], p = 0,0008), а неровность контура определялась достоверно чаще (n = 170 (75%) и n = 30 (54%), p = 0,003). Наоборот, протяженность поражения была больше в группе больных с СС (18 [15; 21,7] мм и 13 [9; 20] мм, p < 0,0001). При ОКС симптом-связанные бляшки (ССБ, n = 87) отличались от симптом-несвязанных бляшек (СНБ, n = 139) более частым наличием неровности контура (n = 72, 83% и n = 97, 70%, p = 0,040), более высокими значениями бремени (90,0 [80,0; 99,0]% и 70,0 [60,0; 85,0]%, p = 0,0001) и протяженности (15 [10; 22] мм и 12 [8; 18] мм, p = 0,038). Достоверных различий остальных характеристик в сравниваемых подгруппах АСБ выявлено не было. Заключение. При ОКС достоверно чаще определялись мягкие АСБ, а при СС — кальцинированные, при этом в мягких и комбинированных коронарных АСБ в группе больных с ОКС отмечались достоверно более высокий индекс ремоделирования, меньшая протяженность и более частое выявление неровности контура. У пациентов с ОКС отсутствовали достоверные различия значений большинства КТ характеристик АСБ между ССБ и СНБ, что может быть следствием генерализации процесса дестабилизации бляшек в КА. Aim. To compare the structural features of coronary artery (CA) atherosclerotic plaques (ASP) in patients with stable angina pectoris (SAP) and acute coronary syndrome (ACS) by computed tomography (CT). Material and methods. The study consists of 125 patients: with ACS (n = 94) and SAP (n = 31). CT angiography (Multislice CT 64; 100-120 ml contrast agent) was performed before coronary angiography. We have estimated type, length, burden of ASP, remodeling index (IR), as well as signs of plaque’s vulnerability — the presence of spotty calcifications, positive remodeling of the artery, rough contour, «ring-like” enhancement and area of low X-ray density < 46 HU. Results. In the group of patients with ACS (n = 250 ASP) compared with SAP (n = 81 ASP) frequency of soft plaques was significantly higher and calcified plaques were significantlylower: n = 127 (50,8%) and n = 26 (32,1%), p = 0,0046; n = 24 (9,6%) and n = 25 (30,9%), p = 0,0011. Comparing only soft and combined ASP inthe ACS group (n = 226) and SAP (n =5 6), in the ACS group, the RI was significantly higher (1,20 [1,14; 1,32] and 1,13 [1,05; 1,25], p = 0,0008), and rough contour was determined significantly more often (n = 170 (75%) and n = 30 (54%), p = 0,003). The length of the lesion was greater in the group of patients with SAP (18 [15; 21,7] mm and 13 [9-20] mm, p < 0,0001). In ACS culprit lessions (n = 87) differed from non-culprit lessions (n = 139) in more frequent presence of rough contour (n = 72, 83%, and n = 97, 70%, p = 0,040), higher values of the burden (90,0 [80,0; 99,0]% and 70,0 [60,0; 85,0]%, p = 0,0001) and length (15 [10; 22] mm and 12 [8; 18] mm, p = 0,038). Conclusion. In ACS soft ASP were significantly more often determined, and in SAP – calcified ones. In ACS, compared with SAP, soft and combined coronary ASP had a significantly higher remodeling index, a shorter length and more frequent detection of contour irregularities. In patients with ACS, there were no significant differences in most of CT plaque’s characteristics between culprit and non-culprit lessions, which may be a consequence of the “generalization of the process plaque’s destabilizing”

Features and Outcomes of Patients with Calcified Nodules at Culprit Lesions of Acute Coronary Syndrome: An Optical Coherence Tomography Study

Cardiology ◽  
2018 ◽  
Vol 139 (2) ◽  
pp. 90-100 ◽  
Author(s):  
Nobuaki Kobayashi ◽  
Masamichi Takano ◽  
Masafumi Tsurumi ◽  
Yusaku Shibata ◽  
Suguru Nishigoori ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Acute Coronary Syndrome ◽  
Plaque Rupture ◽  
Target Lesion ◽  
Cross Sectional Area ◽  
Optical Coherence ◽  
Sectional Area ◽  
Culprit Lesion ◽  
Cross Sectional ◽  
Coronary Syndrome

Objectives: We sought to clarify clinical features and outcomes related to calcified nodules (CN) compared with plaque rupture (PR) and plaque erosion (PE) detected by optical coherence tomography (OCT) at the culprit lesions in patients with acute coronary syndrome (ACS). Methods: Based on OCT findings for culprit lesion plaque morphologies, ACS patients with analyzable OCT images (n = 362) were classified as CN, PR, PE, and other. Results: The prevalence of CN, PR, and PE was 6% (n = 21), 45% (n = 163), and 41% (n = 149), respectively. Patients with CN were older (median 71 vs. 65 years, p = 0.03) and more diabetic (71 vs. 35%, p = 0.002) than those without CN. In OCT findings, the distal reference lumen cross-sectional area (median 4.2 vs. 5.2 mm2, p = 0.048) and the postintervention minimum lumen cross-sectional area (median 4.5 vs. 5.3 mm2, p = 0.04) were smaller in lesions with CN than in those without. Kaplan-Meier estimate survival curves showed that the 500-day survival without target lesion revascularization (TLR) was lower (p = 0.011) for patients with CN (72.9%) than for those with PR (89.3%) or PE (94.8%). Conclusions: ACS patients with CN at the culprit lesion had more TLR compared to those with PR or PE.

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