Abstract 1984: Histopathologic Validation of Virtual Histology Intravascular Ultrasound Analysis of Peri-calcific Necrotic Core Area

The effect of calcium-associated acoustic shadowing on Virtual Histology intravascular ultrasound (VH-IVUS) plaque component analysis is unknown. Methods. We harvested 87 coronary arteries from 30 autopsied specimens. IVUS imaging was performed 50mm from the LMCA ostium. We then selected 10 calcified segments for comparative VH-IVUS vs pathologic comparisons. Results. Pt age was 46±8.9yrs and 90% were males. VH-IVUS analysis of the calcified plaque showed 11±3.8% necrotic core, 8±1.9% fibrofatty plaque, 69±9.9% fibrotic plaque, and 10±6.6% dense calcium. Dense calcium was correlated with the size of the necrotic core (r=0.774, p=0.009). Three coronary arteries with moderate to severe calcium were examined histopathologically. VH-IVUS analysis showed fibrotic tissue behind the calcium, but histopathology showed an acellular sclerotic area (dense collagenous tissue) just beneath the calcium with a relatively well-preserved vascular smooth muscle layer. Within the necrotic core, VH-IVUS showed prominent red necrotic core area combined with calcium; however, histopathology showed empty space of decalcification surrounded by just collagenous tissue with outer smooth muscle actin positive cell layer. More importantly, no active inflammation was present around calcium. Conclusion. VH-IVUS necrotic core surrounding areas of dense calcium correlated with dense collagenous tissue histopathologically. It is important not to overinterpret VH IVUS studies of dense calcium with prominent necrotic core. More precise classification/validation for necrotic core is necessary.

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The maximum necrotic core area is most often located proximally to the site of most severe narrowing: a virtual histology intravascular ultrasound study

Heart and Vessels ◽

10.1007/s00380-012-0236-7 ◽

2012 ◽

Vol 28 (2) ◽

pp. 166-172 ◽

Cited By ~ 11

Author(s):

Michiel A. de Graaf ◽

Joella E. van Velzen ◽

Fleur R. de Graaf ◽

Joanne D. Schuijf ◽

Jouke Dijkstra ◽

...

Keyword(s):

Intravascular Ultrasound ◽

Necrotic Core ◽

Core Area ◽

Virtual Histology ◽

Virtual Histology Intravascular Ultrasound ◽

Ultrasound Study

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VIRTUAL HISTOLOGY–INTRAVASCULAR ULTRASOUND IN ASSESSMENT OF CAROTID PLAQUES

Neurosurgery ◽

10.1227/01.neu.0000346271.31050.af ◽

2009 ◽

Vol 65 (1) ◽

pp. 146-152 ◽

Cited By ~ 12

Author(s):

Tomohito Hishikawa ◽

Koji Iihara ◽

Hatsue Ishibashi-Ueda ◽

Kazuyuki Nagatsuka ◽

Naoaki Yamada ◽

...

Keyword(s):

Intravascular Ultrasound ◽

Ex Vivo ◽

Necrotic Core ◽

Interquartile Range ◽

Intraplaque Hemorrhage ◽

Virtual Histology ◽

Carotid Plaques ◽

Virtual Histology Intravascular Ultrasound ◽

Histological Sections ◽

Histological Images

Abstract OBJECTIVE Virtual histology–intravascular ultrasound (VH-IVUS) has been reported to be useful in detecting the components of coronary plaques in vivo. Recently, the application of VH-IVUS to peripheral interventions has been evaluated. The aim of this study was to examine the extent to which the necrotic core of carotid plaques could be assessed accurately by VH-IVUS compared with histopathology. METHODS A total of 37 carotid plaques underwent ex vivo VH-IVUS within 24 hours after endarterectomy. Ninety-five segments of virtual histological images were matched to histological sections. The area of the necrotic core on histological sections was compared with that on virtual histological images. Intraplaque hemorrhage (IPH) was histopathologically graded by its severity using immunohistochemical staining for glycophorin A as a marker. The relationship of the severity of the IPH to the necrotic core was histopathologically evaluated. The correlation between the necrotic core or IPH with symptomatology was also evaluated. RESULTS The area of the necrotic core on virtual histological images (median, 8.0%; interquartile range, 5.0%–13%) was significantly smaller compared with that of the histological sections (median, 50%; interquartile range, 40%–63%) (P < 0.0001). The Bland-Altman analysis showed poor agreement in the necrotic core measurement between virtual histological images and histological sections (mean difference, 39.8%; 95% confidence interval, 35.8%–43.8%). Severe IPH was significantly associated with a larger necrotic core and symptomatology (P < 0.0001 and P = 0.0039, respectively). The area of necrotic core on the virtual histological analysis did not correlate with symptomatology (P = 0.70), but that on pathological analysis tended to correlate with symptomatology (P = 0.059). CONCLUSION In the present virtual histological algorithm, the underestimation of the necrotic core was revealed. The lack of a hemorrhage component in the virtual histological algorithm is a leading cause of its underestimation.

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Abstract 1982: In Vivo Virtual Histology Intravascular Ultrasound Correlates of Risk Factors for Sudden Coronary Death in Men: Results from the Prospective, Global, Multi-center VH-IVUS Registry

Circulation ◽

10.1161/circ.116.suppl_16.ii_428 ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Eduardo Missel ◽

Gary S Mintz ◽

Stephane G Carlier ◽

Jie Qian ◽

Shoujie Shan ◽

...

Keyword(s):

Risk Factors ◽

Intravascular Ultrasound ◽

Density Lipoprotein ◽

Necrotic Core ◽

Consecutive Series ◽

Virtual Histology ◽

Virtual Histology Intravascular Ultrasound ◽

Coronary Death ◽

Sudden Coronary Death

Background: Histopathological data shows that cigarette smoking and a total-cholesterol-to-high-density-lipoprotein ratio (TC/HDL) >5 are associated to sudden coronary death (SCD) in men. We hypothesized a relationship between virtual histology intravascular ultrasound (VH-IVUS) findings and these risk factors. Methods and Results: We performed whole pullback VH-IVUS analyses in a consecutive series of 473 male pts and measured the four basic VH-IVUS coronary plaque components - fibrous (FI), fibro-fatty (FF), dense calcium (DC) and necrotic core (NC) - as well as calculated a NC/DC ratio. Pts age was 61±11years, with 27% current smokers and 69% with a lipid disorder. Among VH-IVUS parameters, the NC/DC ratio was the only parameter related both to the TC/HDL ratio (r=0.18, p=0.0008) and LDL-C levels (r=0.17, p=0.002); it had a negative correlation with HDL-C levels (r=0.11, p=0.03), and was significantly higher for smokers [median: 1.98 (1.35, 3.18)] vs. non-smokers [median: 1.70 (1.23, 2.53), p=0.006]. A NC/DC value >3 was the threshold that best identified smokers with a TC/HDL>5 (odds ratio 3.0, p=0.0001). ROC curves showed superiority of the NC/DC ratio (A 2 : 0.64, p<0.0001) over %DC (A 2 : 0.58, p=0.006) or %NC (A 2 : 0.51, p=0.43) as isolate parameters to identify pts with a risk profile for SCD (Figure ). Conclusions: In diseased coronary segments the ratio of necrotic core to calcification detected by VH-IVUS is related to previously-published pathologic risk factors for SCD.

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