Faculty Opinions recommendation of Morphology of exertion-triggered plaque rupture in patients with acute coronary syndrome: an optical coherence tomography study.

2009 ◽  
Author(s):  
John Ambrose
Keyword(s):  
Optical Coherence Tomography ◽  
Acute Coronary Syndrome ◽  
Plaque Rupture ◽  
Optical Coherence ◽  
Coronary Syndrome

scholarly journals Potential relationship between high wall shear stress and plaque rupture that cause acute coronary syndrome: insights from optical coherence tomography based computational fluid dynamic simulation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y Fukuyama ◽  
H Otake ◽  
F Seike ◽  
H Kawamori ◽  
T Toba ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Shear Stress ◽  
Acute Coronary Syndrome ◽  
Wall Shear Stress ◽  
Plaque Rupture ◽  
Optical Coherence ◽  
Lumen Area ◽  
Segmental Analysis ◽  
Coronary Syndrome ◽  
Fibrous Cap

Abstract Background The direct relationship between plaque rupture (PR) that cause acute coronary syndrome (ACS) and wall shear stress (WSS) remains uncertain. Methods From the Kobe University ACS-OCT registry, one hundred ACS patients whose culprit lesions had PR documented by optical coherence tomography (OCT) were enrolled. Lesion-specific 3D coronary artery models were created using OCT data. Specifically, at the ruptured portion, the tracing of the luminal edge of the residual fibrous cap was smoothly extrapolated to reconstruct the luminal contour before PR. Then, WSS was computed from computational fluid dynamics (CFD) analysis by a single core laboratory. Relationships between WSS and the location of PR were assessed with 1) longitudinal 3-mm segmental analysis and 2) circumferential analysis. In the longitudinal segmental analysis, each culprit lesion was subdivided into five 3-mm segments with respect to the minimum lumen area (MLA) location at the centered segment (Figure. 1). In the circumferential analysis, we measured WSS values at five points from PR site and non-PR site on the cross-sections with PR. Also, each ruptured plaque was categorized into the lateral type PR (L-PR), central type PR (C-PR), and others according to the relation between the site of tearing and the cavity (Figure. 2). Results In the longitudinal 3-mm segmental analysis, the incidences of PR at upstream (UP1 and 2), MLA, and downstream (DN1 and 2) were 45%, 40%, and 15%, respectively. The highest average WSS was located in UP1 in the upstream PR (UP1: 15.5 (10.4–26.3) vs. others: 6.8 (3.3–14.7) Pa, p<0.001) and MLA segment in the MLA PR (MLA: 18.8 (6.0–34.3) vs. others: 6.5 (3.1–11.8) Pa, p<0.001), and the second highest WSS was located at DN1 in the downstream PR (DN1: 5.8 (3.7–11.5) vs. others: 5.5 (3.7–16.5) Pa, p=0.035). In the circumferential analysis, the average WSS at PR site was significantly higher than that of non-PR site (18.7 (7.2–35.1) vs. 13.9 (5.2–30.3) Pa, p<0.001). The incidence of L-PR, C-PR, and others were 51%, 42%, and 7%, respectively. In the L-PR, the peak WSS was most frequently observed in the lateral site (66.7%), whereas that in the C-PR was most frequently observed in the center site (70%) (Figure. 3). In the L-PR, the peak WSS value was significantly lower (44.6 (19.6–65.2) vs. 84.7 (36.6–177.5) Pa, p<0.001), and the thickness of broken fibrous cap was significantly thinner (40 (30–50) vs. 80 (67.5–100) μm, p<0.001), and the lumen area at peak WSS site was significantly larger than those of C-PR (1.5 (1.3–2.0) vs. 1.4 (1.1–1.6) mm2, p=0.008). Multivariate analysis demonstrated that the presence of peak WSS at lateral site, thinner broken fibrous cap thickness, and larger lumen area at peak WSS site were independently associated with the development of the L-PR. Conclusions A combined approach with CFD simulation and morphological plaque evaluation by using OCT might be helpful to predict future ACS events induced by PR. Funding Acknowledgement Type of funding source: None

scholarly journals A case report of cocaine abuse, acute coronary syndrome, and eroded plaque: stent or not stent?

2021 ◽  
Vol 5 (6) ◽  
Author(s):  
Isabel Muñoz Pousa ◽  
Ubaldo Hernández ◽  
Victor A Jiménez Díaz
Keyword(s):  
Optical Coherence Tomography ◽  
Acute Coronary Syndrome ◽  
Plaque Rupture ◽  
Imaging Techniques ◽  
Optical Coherence ◽  
Active Smoking ◽  
Tomography Imaging ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Optical Coherence Tomography Imaging

Abstract Background Intracoronary imaging techniques have allowed characterizing atherosclerotic plaques morphologically in patients with the acute coronary syndrome (ACS). Although the main feature described is plaque rupture, the use of optical coherence tomography has made it possible to objectify that the eroded plaque is not uncommon in this setting. Case summary We presented a case of a 45-year-old man with active smoking and cocaine user, admitted to the emergency department for chest pain. The electrocardiogram showed ST-segment elevation myocardial infarction (STEMI) in the inferior leads. Emergent coronary angiography was performed, showing thrombotic occlusion of mid-distal right coronary artery. After successful thromboaspiration, no areas of significant angiographic stenosis were observed. Optical coherence tomography imaging at the occlusion site revealed an eroded plaque and a remaining small thrombusburden. Conservative management without stent implantation was decided. Treatments consisted of an acute phase glycoprotein IIb/IIIa inhibitor and subsequently dual antiplatelet therapy with Aspirin (ASA) and Ticagrelor 90 mg b.i.d. for 12 months. The patient remains asymptomatic and uneventful at 9-month follow-up. Discussion Young age, history of active smoking, and cocaine use are common clinical features in patients with ACS due to an eroded plaque. These patients frequently display a STEMI with the involvement of a single coronary vessel. Optical coherence tomography imaging aids to a precise diagnosis and to define a proper treatment.

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.

Matrix Metalloproteinase-9 as a Marker for Plaque Rupture and a Predictor of Adverse Clinical Outcome in Patients with Acute Coronary Syndrome: An Optical Coherence Tomography Study

Cardiology ◽  
2016 ◽  
Vol 135 (1) ◽  
pp. 56-65 ◽  
Author(s):  
Nobuaki Kobayashi ◽  
Masamichi Takano ◽  
Noritake Hata ◽  
Noriaki Kume ◽  
Masafumi Tsurumi ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Acute Coronary Syndrome ◽  
Matrix Metalloproteinase ◽  
Plaque Rupture ◽  
Matrix Metalloproteinase 9 ◽  
Plaque Morphology ◽  
Optical Coherence ◽  
Coronary Syndrome ◽  
Creatine Kinase Mb ◽  
Metalloproteinase 9

Objectives: The present study sought to clarify the relationship between matrix metalloproteinase-9 (MMP-9) levels and plaque morphology demonstrated by optical coherence tomography (OCT), and to examine their prognostic impacts in patients with acute coronary syndrome (ACS). Methods: MMP-9 levels were measured for patients with ACS (n = 249). Among 249 patients, 120 with evaluable OCT images were categorized into patients with ruptured plaques (n = 65) and those with nonruptured plaques (n = 55) on the basis of culprit lesion plaque morphology demonstrated by OCT. Results: MMP-9 levels on admission were significantly higher in the rupture group than in the nonrupture group (p = 0.029). Although creatine kinase-MB (CK-MB) on admission was comparable between the groups, peak CK-MB was higher in the rupture group than in the nonrupture group (p < 0.001). By receiver operating characteristic curve analysis, the optimal cut-off value of MMP-9 to detect ruptured plaques was 65.5 ng/ml (p = 0.029). There was a nonstatistically significant trend toward increased cardiac death at 2 years (5.9 vs. 1.0%, p = 0.059) in patients with high MMP-9 (≥65.5 ng/ml) compared to those with low MMP-9 (<65.5 ng/ml). Conclusions: MMP-9 can differentiate ACS with ruptured plaques from nonruptured plaques, and MMP-9 may be a valuable predictor of long-term cardiac mortality in patients with ACS reflecting plaque rupture.

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.

scholarly journals Relationship between monocyte-to-lymphocyte ratio and coronary plaque vulnerability in patients with acute coronary syndrome: an optical coherence tomography study

2019 ◽  
Author(s):  
Ting-yu Zhang ◽  
Qi Zhao ◽  
Ze-sen Liu ◽  
Chao-yi Zhang ◽  
Jie Yang ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Acute Coronary Syndrome ◽  
Plaque Rupture ◽  
Coronary Plaque ◽  
Plaque Morphology ◽  
Multivariable Logistic Regression Analysis ◽  
Optical Coherence ◽  
Plaque Vulnerability ◽  
Lymphocyte Ratio ◽  
Coronary Syndrome

Abstract Background The importance of monocyte-to-lymphocyte ratio (MLR) has been indicated in the initiation and progression of coronary artery disease (CAD). However, few previous researches demonstrated the relationship between MLR and plaque vulnerability. We aimed to investigate coronary plaque vulnerability in patients with acute coronary syndrome (ACS) by optical coherence tomography (OCT). Methods A total of 72 ACS patients who underwent coronary angiography and OCT test in Beijing Anzhen hospital were included in this retrospective study. The plaque vulnerability and plaque morphology were assessed by OCT. Results The coronary plaque in high MLR group exhibited more vulnerable features, characterizing as thinner thickness of fibrous cap (FCT)(112.37 ± 60.24 vs 153.49 ± 73.29 μm, P = 0.013), greater maximum lipid core angle (167.36 ± 62.33 vs 138.79 ± 56.37°, P = 0.010) and longer lipid plaque length (6.34 ± 3.12 vs 4.50 ± 2.21mm, P = 0.041). A prominently negative liner relation was found between MLR and FCT (R = 0.225, P < 0.005). Meanwhile, the incidence of OCT-detected thin cap fibro-atheroma (TCFA) (44.7% vs 18.4%, P = 0.014) and plaque rupture (36.8% vs 13.2%, P = 0.017) were higher in high MLR group. Most importantly, multivariable logistic regression analysis showed MLR level was related to the presence of TCFA (OR:3.316，95%：1.448-7.593，P = 0.005). MLR level could differentiate TCFA with a sensitivity of 72.0% and a specificity of 66.1%. Conclusion Circulating MLR level has potential value in identifying the presence of vulnerable plaque in patients with ACS. MLR, as a non- invasive biomarker of inflammation, may be valuable in revealing plaque vulnerability. Key words Monocyte-to-lymphocyte ratio, Optical coherence tomography, Plaque vulnerability

scholarly journals The relationship between residual cholesterol risk and plaque characteristics in patients with acute coronary syndrome evaluated by optical coherence tomography

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y.N Gao ◽  
W Liu ◽  
Y.J Zhou ◽  
S.J Wu
Keyword(s):  
Optical Coherence Tomography ◽  
Acute Coronary Syndrome ◽  
Plaque Rupture ◽  
Density Lipoprotein ◽  
Major Adverse Cardiovascular Events ◽  
Funding Source ◽  
Optical Coherence ◽  
Fibrous Plaque ◽  
Coronary Syndrome ◽  
Hs Crp

Abstract Background It has been demonstrated that high sensitive-C reactive protein (hs-CRP) and low density lipoprotein cholesterol (LDL-C) are independently associated with major adverse cardiovascular events (MACEs). Whether the level of LDL has impact on plaque characteristics in acute coronary syndrome (ACS) patients with normal hs-CRP are still unknown. Methods We retrospectively enrolled ACS patients with the level of hs-CRP&lt;2mg/L on admission from 1st January, 2017 to 31st December,2017, from our hospital. All patients underwent pre-intervention optical coherence tomography (OCT) to evaluate the plaque characteristics. Residual cholesterol risk (RCR) was defined as LDL-C≥1.8mmol/L, while hs-CRP&lt;2mg/L. According to the level of baseline LDL-C, patients were divided into RCR group and non-RCR group. Results A total of 90 patients (94 vessels) were included, with 50 patients in RCR group and 40 patients in non-RCR group. Compared with non-RCR group, patients in RCR group had higher levels of total cholesterol (4.39±0.89 vs 3.05±0.48, p=0.000), LDL-C (2.56±0.57 vs 1.54±0.22, p=0.000), triglycerides (1.11±1.12 vs 1.02±0.74, p=0.003). Patients in RCR group were younger (54.0±11.04 vs 58.4±9.59, p=0.049) and had higher rate of multivessel disease (6.0% vs 2.5%, p=0.028) than those in non-RCR group. With regard to plaque characteristics, fibrous plaque (0.0% vs 12.5%, p=0.003) was less seen and atherosclerotic plaque (79.6% vs 50.0%, p=0.028) was more seen in RCR group. In addition, patients in RCR group had significantly higher rate of plaque rupture than that in non-RCR group (24.1% vs 5%, p=0.008). To be noticed, cholesterol crystal and thin-cap fibroatheroma (TCFA) were more commonly in RCR group, though the difference was not statistical. Conclusion Patients with RCR have a great extent of plaque rupture, indicating more vulnerable plaque phenotype. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): China Youth Clinical Research Foundation-VG Foundation

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