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Detection of Vulnerable Coronary Plaques Using Invasive and Non-Invasive Imaging Modalities. J Clin Med 2022; 11:jcm11051361. [PMID: 35268451 PMCID: PMC8911129 DOI: 10.3390/jcm11051361] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/11/2022] [Accepted: 02/25/2022] [Indexed: 11/16/2022] Open
Abstract
Acute coronary syndrome (ACS) mostly arises from so-called vulnerable coronary plaques, particularly prone for rupture. Vulnerable plaques comprise a specific type of plaque, called the thin-cap fibroatheroma (TFCA). A TCFA is characterized by a large lipid-rich necrotic core, a thin fibrous cap, inflammation, neovascularization, intraplaque hemorrhage, microcalcifications or spotty calcifications, and positive remodeling. Vulnerable plaques are often not visible during coronary angiography. However, different plaque features can be visualized with the use of intracoronary imaging techniques, such as intravascular ultrasound (IVUS), potentially with the addition of near-infrared spectroscopy (NIRS), or optical coherence tomography (OCT). Non-invasive imaging techniques, such as computed tomography coronary angiography (CTCA), cardiovascular magnetic resonance (CMR) imaging, and nuclear imaging, can be used as an alternative for these invasive imaging techniques. These invasive and non-invasive imaging modalities can be implemented for screening to guide primary or secondary prevention therapies, leading to a more patient-tailored diagnostic and treatment strategy. Systemic pharmaceutical treatment with lipid-lowering or anti-inflammatory medication leads to plaque stabilization and reduction of cardiovascular events. Additionally, ongoing studies are investigating whether modification of vulnerable plaque features with local invasive treatment options leads to plaque stabilization and subsequent cardiovascular risk reduction.
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Tsujimura T, Ishihara T, Iida O, Hata Y, Toyoshima T, Higashino N, Kurata N, Asai M, Masuda M, Okamoto S, Nanto K, Kanda T, Matsuda Y, Mano T. Arterial Healing 10 Months After Implantation of an Ultrathin-Strut, Biodegradable-Polymer, Sirolimus-Eluting Stent - An Angioscopic Study. Circ Rep 2021; 3:316-323. [PMID: 34136706 PMCID: PMC8180372 DOI: 10.1253/circrep.cr-21-0053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 05/06/2021] [Indexed: 12/02/2022] Open
Abstract
Background: The OrsiroTM ultrathin-strut, biodegradable-polymer, sirolimus-eluting stent (O-SES) has specific characteristics regarding its components and has demonstrated comparable clinical outcomes compared with durable-polymer, drug-eluting stents (DES). However, arterial repair following deployment of the O-SES has not been elucidated to date. Methods and Results: Using data from the Kansai Rosai Hospital database between November 2010 and September 2020, we analyzed coronary angioscopy (CAS) findings a mean (±SD) of 10±2 months after implantation of an O-SES, a durable-polymer everolimus-eluting stent (XienceTM; X-EES), or a biodegradable-polymer everolimus-eluting stent (SynergyTM; S-EES). Neointimal coverage (NIC), yellow color intensity of the stented segment, and the incidence of thrombus adhesion were compared between the O-SES (66 stents from 42 patients), X-EES (119 stents from 87 patients), and S-EES (132 stents from 88 patients). NIC was significantly thinner for the O-SES than S-EES (P<0.001), but was similar between the O-SES and X-EES (P=0.25). Yellow color intensity was significantly greater for the O-SES than X-EES (P<0.001), but similar between the O-SES and S-EES (P=0.51). The incidence of thrombus adhesions was similar in all 3 groups. Conclusions: O-SES and X-EES resulted in similar inhibition of NIC and both resulted in a thinner NIC than with S-EES. In addition, O-SES exhibited a similar degree of thrombus adhesion as the other DES, suggesting similar thrombogenicity.
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Affiliation(s)
| | | | - Osamu Iida
- Kansai Rosai Hospital Cardiovascular Center Amagasaki Japan
| | - Yosuke Hata
- Kansai Rosai Hospital Cardiovascular Center Amagasaki Japan
| | - Taku Toyoshima
- Kansai Rosai Hospital Cardiovascular Center Amagasaki Japan
| | | | - Naoya Kurata
- Department of Clinical Engineering, Kansai Rosai Hospital Amagasaki Japan
| | | | | | - Shin Okamoto
- Kansai Rosai Hospital Cardiovascular Center Amagasaki Japan
| | - Kiyonori Nanto
- Kansai Rosai Hospital Cardiovascular Center Amagasaki Japan
| | - Takashi Kanda
- Kansai Rosai Hospital Cardiovascular Center Amagasaki Japan
| | | | - Toshiaki Mano
- Kansai Rosai Hospital Cardiovascular Center Amagasaki Japan
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Xu M, Demuyakor A, Hu S, Liu H, Zhao C, Chen T, Qin Y, Xu Y, Feng X, Zeng M, Weng Z, Gao Z, Hou J, Jia H, Zhang S, Yu B. Is the effect of atorvastatin 60 mg on stabilization of lipid-rich plaque equivalent to that of rosuvastatin 10 mg? A serial optical coherence tomography combined with intravascular ultrasound imaging. Catheter Cardiovasc Interv 2021; 97 Suppl 2:1097-1107. [PMID: 33864710 DOI: 10.1002/ccd.29654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 03/14/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES This study aimed to compare the effect of atorvastatin 60 (AT60) mg to that of rosuvastatin 10 (RT10) mg on the morphological changes in lipid-rich plaques (LRPs) and plaque volume, using serial optical coherence tomography (OCT) and intravascular ultrasound imaging (IVUS). BACKGROUND Intensive lipid lowering therapy by statin provides more clinical benefit compared to that of moderate lipid lowering therapy. METHODS Fifty patients who underwent OCT and IVUS at baseline, 6, and 12 months were grouped by statin therapy into the AT60 mg (n = 27) and RT10 mg (n = 23) groups. The relationships between absolute and percentage changes in biomarkers and fibrous cap thickness (FCT) during follow-up were investigated using a simple regression analysis. RESULTS At 6 months, the mean low-density lipoprotein cholesterol level reduced from 113.5 to 65.5 mg/dl (AT60 mg group) and 100.2 to 72.2 mg/dl (RT10 mg groups). A continuous increase in FCT from baseline to 12 months was observed in both groups (p < .001, p < .001, respectively). Mean lipid arc significantly decreased in both AT60 mg (189.0 ± 55.9°, 170.9 ± 60.2°, 155.6 ± 50.6°, p < .001) and RT10 mg (160.0 ± 45.6°, 151.2 ± 48.5°, 141.1 ± 52.9°, p = .010) groups. Plaque burden did not change significantly in both groups. CONCLUSIONS Lipid-lowering therapy effect with AT60 mg was equivalent to that of RT10 mg in terms of change in plaque morphology. AT60 mg showed more intensive low-density lipid cholesterol level reduction compared to RT10 mg while RT10 mg was effective in increasing the high-density lipid cholesterol level. Both statin therapies could effectively stabilize LRPs.
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Affiliation(s)
- Maoen Xu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Abigail Demuyakor
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Sining Hu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Huimin Liu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Chen Zhao
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Tao Chen
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Yuhan Qin
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Yishuo Xu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Xue Feng
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Ming Zeng
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Ziqian Weng
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Zhanqun Gao
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Jingbo Hou
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Haibo Jia
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Shuo Zhang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Bo Yu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
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Mitsutake Y, Yano H, Ishihara T, Matsuoka H, Ueda Y, Ueno T. Consensus document on the standard of coronary angioscopy examination and assessment from the Japanese Association of Cardiovascular Intervention and Therapeutics. Cardiovasc Interv Ther 2021; 37:35-39. [PMID: 33743168 DOI: 10.1007/s12928-021-00770-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 03/12/2021] [Indexed: 11/24/2022]
Abstract
Coronary angioscopy (CAS) is a unique diagnostic device that allows direct visualization of the vascular luminal surface in living patients. CAS contributes to elucidate the pathology of coronary artery disease. This consensus document provides a standard for CAS examination and assessment.
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Affiliation(s)
- Yoshiaki Mitsutake
- Division of Cardiovascular Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan.
| | - Hideto Yano
- Division of Cardiology, Gyotoku General Hospital, Chiba, Japan
| | | | - Hiroshi Matsuoka
- Department of General Medicine, Ehime Prefectural Central Hospital, Ehime, Japan
| | - Yasunori Ueda
- Cardiovascular Division, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Takafumi Ueno
- Division of Cardiology, Fukuoka Memorial Hospital, Fukuoka, Japan
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WANG Y, ZHANG SS, LV QB, LI Y, ZHAO J, HAN J, FU GS, ZHANG WB. Comparison of low-density lipoprotein cholesterol/high-density lipoprotein cholesterol and total cholesterol/high-density lipoprotein cholesterol for the prediction of thin-cap fibroatheroma determined by intravascular optical coherence tomography. J Geriatr Cardiol 2020; 17:666-673. [PMID: 33343645 PMCID: PMC7729182 DOI: 10.11909/j.issn.1671-5411.2020.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 10/20/2020] [Accepted: 11/05/2020] [Indexed: 04/24/2023] Open
Abstract
BACKGROUND The correlation among the ratios of low-density lipoprotein cholesterol/high-density lipoprotein cholesterol (LDL-C/ HDL-C), total cholesterol/high-density lipoprotein cholesterol (TC/HDL-C) and thin-cap fibroatheroma has not yet been established. METHODS It was a single center, retrospective observational study. In total, we recruited 421 patients (82.4% men; mean age 65.73 ± 10.44 years) with one culprit vessel which determined by intravascular optical coherence tomography (OCT). The thinnest-capped fibroatheroma (TCFA) group was defined as lipid contents in > 2 quadrants, with the thinnest fibrous cap measuring less than 65 μm. Univariate and multivariate logistic regression were carried out to explore the relationship between lipoprotein ratios, TCFA and other characteristics of plaque. To compare different ratios, the area under curve (AUC) of receiver-operating characteristic (ROC) curve was assessed. RESULTS OCT was performed in 421 patients (TCFA group (n = 109), non-TCFA group (n = 312)). LDL-C/HDL-C in the TCFA group was significantly higher than in the non-TCFA group (2.95 ± 1.20 vs. 2.43 ± 0.92, P < 0.05), as was TC/LDL in TCFA and non-TCFA group (4.57 ± 1.58 vs. 4.04 ± 1.13, P < 0.05). Both LDL-C/HDL-C (OR: 1.002 (1.002-1.003), P < 0.05) and TC/HDL-C (OR: 1.001 (1.001-1.004), P < 0.05) were considered independent factors for the prediction of TCFA according to the logistic regression. Based on the AUC comparison, LDL-C/ HDL-C and TC/HDL-C had no significant difference statistically (LDL-C/HDL-C AUC: 0.63; TC/HDL-C AUC: 0.61; P = 0.10) for the prediction of TCFA. CONCLUSIONS LDL-C/HDL-C and TC/HDL-C could be the independent factors for predicting the presence of TCFA, indicating coronary plaque vulnerability in CAD patients. Moreover, TC/HDL-C also showed a comparative performance for the prediction of TCFA as LDL-C/HDL-C.
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Affiliation(s)
- Yao WANG
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Si-Si ZHANG
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qing-Bo LV
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ya LI
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jin ZHAO
- Department of Infection Control, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jia HAN
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Guo-Sheng FU
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Wen-Bin ZHANG
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Eldomi S, Zafar J, Sengupta R, Sharif F, Zafar H. Optical imaging techniques for vulnerable plaque detection. TRANSLATIONAL BIOPHOTONICS 2020. [DOI: 10.1002/tbio.201900034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Suleiman Eldomi
- Lambe Institute for Translational Research School of Medicine, National University of Ireland Galway Galway Ireland
- Cardiovascular Research & Innovation Centre National University of Ireland Galway Galway Ireland
| | - Junaid Zafar
- Faculty of Engineering Government College University Lahore Lahore Pakistan
| | - Ritasree Sengupta
- Lambe Institute for Translational Research School of Medicine, National University of Ireland Galway Galway Ireland
- Cardiovascular Research & Innovation Centre National University of Ireland Galway Galway Ireland
| | - Faisal Sharif
- Lambe Institute for Translational Research School of Medicine, National University of Ireland Galway Galway Ireland
- Cardiovascular Research & Innovation Centre National University of Ireland Galway Galway Ireland
- Department of Cardiology University Hospital Galway Galway Ireland
- CÚRAM‐SFI Centre for Research in Medical Devices Galway Ireland
- BioInnovate Galway Ireland
| | - Haroon Zafar
- Lambe Institute for Translational Research School of Medicine, National University of Ireland Galway Galway Ireland
- Cardiovascular Research & Innovation Centre National University of Ireland Galway Galway Ireland
- BioInnovate Galway Ireland
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Khan MH, Rochlani Y, Yandrapalli S, Aronow WS, Frishman WH. Vulnerable Plaque: A Review of Current Concepts in Pathophysiology and Imaging. Cardiol Rev 2020; 28:3-9. [PMID: 30489331 DOI: 10.1097/crd.0000000000000238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Advances in our understanding of the natural history and biology of atherosclerotic vascular disease led to the concept of a vulnerable plaque (VP), which is predisposed toward more rapid progression and acute coronary events. With newer technologies, we now have at our disposal high-quality imaging studies, both invasive and noninvasive, which promise in identifying plaque characteristics that make it more vulnerable. Upcoming trials aim to evaluate the utility of imaging VP in predicting clinical events. We discuss the role of VP imaging in managing atherosclerotic vascular disease.
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Affiliation(s)
- Mohammed Hasan Khan
- From the Cardiology Division, Department of Medicine, New York Medical College and Westchester Medical Center, Valhalla, NY
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8
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Kurihara O, Thondapu V, Kim HO, Russo M, Sugiyama T, Yamamoto E, Fracassi F, Minami Y, Wang Z, Lee H, Yonetsu T, Jang IK. Comparison of Vascular Response to Statin Therapy in Patients With Versus Without Diabetes Mellitus. Am J Cardiol 2019; 123:1559-1564. [PMID: 30851939 DOI: 10.1016/j.amjcard.2019.02.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 02/08/2019] [Accepted: 02/13/2019] [Indexed: 11/17/2022]
Abstract
Diabetes mellitus (DM) increases cardiovascular morbidity and mortality. A statin is routinely prescribed to patients with DM. However, whether a statin therapy is equally effective in plaque stabilization in DM patients compared with non-DM patients is unknown. A total of 117 lipid-rich plaques were imaged in 90 patients (54 plaques in 41 DM patients and 63 plaques in 49 non-DM patients) with coronary artery disease, those who were treated with a statin and underwent serial optical coherence tomography imaging were included in this study (mean follow-up period, 362 ± 38 days). The changes in minimum fibrous cap thickness (FCT) and lipid index between baseline and 1-year follow-up were compared between the 2 groups. Minimum FCT increased and lipid index decreased with statin therapy in both groups. No significant differences were observed in percent changes of minimum FCT (p = 0.796) and lipid index (p = 0.336) between DM and non-DM patients. Statin therapy induced a significant increase in FCT and a significant decrease in lipid index in both groups. Vascular response to statin therapy was similar between the 2 groups irrespective of DM status.
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Affiliation(s)
- Osamu Kurihara
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Vikas Thondapu
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Hyung Oh Kim
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michele Russo
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Tomoyo Sugiyama
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Erika Yamamoto
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Francesco Fracassi
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Yoshiyasu Minami
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Zhao Wang
- University of Electronic Science and Technology of China, Chengdu, China
| | - Hang Lee
- Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Taishi Yonetsu
- Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Ik-Kyung Jang
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Division of Cardiology, Kyung Hee University Hospital, Seoul, Republic of Korea.
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Nakamura D, Yasumura K, Nakamura H, Matsuhiro Y, Yasumoto K, Tanaka A, Matsunaga-Lee Y, Yano M, Yamato M, Egami Y, Shutta R, Sakata Y, Tanouchi J, Nishino M. Different Neoatherosclerosis Patterns in Drug-Eluting- and Bare-Metal Stent Restenosis - Optical Coherence Tomography Study. Circ J 2019; 83:313-319. [PMID: 30487370 DOI: 10.1253/circj.cj-18-0701] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2024]
Abstract
BACKGROUND There are few reports about the differences between drug-eluting stents (DES) and bare metal stents (BMS) in neoatherosclerosis associated with in-stent restenosis (ISR), so we compared the frequency and characteristics of neoatherosclerosis with ISR evaluated by optical coherence tomography (OCT) in the present study. METHODS AND RESULTS Between March 2009 and November 2016, 98 consecutive patients with ISR who underwent diagnostic OCT were enrolled: 34 patients had a BMS, 34 had a 1st-generation DES, and 30 had a 2nd-generation DES. Neoatherosclerosis was defined as a lipid neointima (including a thin-cap fibroatheroma [TCFA] neointima, defined as a fibroatheroma with a fibrous cap <65 µm) or calcified neointima. As a result, lipid neointima, TCFA neointima and calcified neointima were detected in 39.8%, 14.3%, and 5.1%, respectively, of all patients. The frequency of neoatherosclerosis was significantly greater with DES than BMS (48.4% vs. 23.5%, P=0.018). The minimum fibrous cap thickness was significantly thicker with DES than BMS (110.3±41.1 µm vs. 62.5±17.1 µm, P<0.001). In addition, longitudinal extension of neoatherosclerosis in the stented segment was less with DES than BMS (20.2±15.1% vs. 71.8±27.1%, respectively, P=0.001). CONCLUSIONS OCT imaging demonstrated that neoatherosclerosis with ISR was more frequent with DES than BMS and its pattern exhibited a more focal and thick fibrous cap as compared with BMS.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Ryu Shutta
- Division of Cardiology, Osaka Rosai Hospital
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
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Shibuya M, Fujii K, Hao H, Imanaka T, Saita T, Kawakami R, Miki K, Tamaru H, Horimatsu T, Sumiyoshi A, Nishimura M, Hirota S, Masuyama T, Ishihara M. Atherosclerotic Component of the Yellow Segment After Drug-Eluting Stent Implantation on Coronary Angioscopy - An Ex-Vivo Validation Study. Circ J 2018; 83:193-197. [PMID: 30393245 DOI: 10.1253/circj.cj-18-0671] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2024]
Abstract
BACKGROUND Coronary angioscopy (CAS) is used to comprehensively evaluate vascular responses after drug-eluting stent (DES) implantation. This study sought to evaluate the capability of CAS for evaluating DES strut coverage grade and color grade of the intima compared with histological images in coronary autopsy specimens. METHODS AND RESULTS A total of 23 DES extracted from 11 autopsy hearts were imaged by CAS. All stent segments were graded as white or yellow according to the luminal surface color, and thrombus was evaluated according to a previous report. Neointimal coverage over the DES was graded as 0 (stent struts fully visible) to grade 3 (stent struts fully embedded and invisible). Of 76 segments, neointimal coverage was graded as 0 in 35 (46%), 1 in 22 (29%), 2 in 8 (11%), and 3 in 11 (14%). The neointimal thickness increased significantly with increasing neointimal coverage grade on angioscopy. Neointimal color was graded as white in 40 (53%) and yellow in 36 segments (47%). Histological analysis revealed that yellow neointima contained fibroatheroma, foam cells accumulation or superficial calcium deposition. A thrombus was identified in 13 segments. Thrombi adherent around the stent strut were partly intimal erythrocyte accumulation around the strut. CONCLUSIONS In-stent yellow segment had atherosclerotic components. CAS could evaluate vascular status comprehensively after DES implantation.
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Affiliation(s)
- Masahiko Shibuya
- Division of Cardiovascular Medicine and Coronary Heart Disease, Hyogo College of Medicine
| | - Kenichi Fujii
- Department of Surgical Pathology, Hyogo College of Medicine
| | - Hiroyuki Hao
- Department of Pathology, Nihon University School of Medicine
| | - Takahiro Imanaka
- Division of Cardiovascular Medicine and Coronary Heart Disease, Hyogo College of Medicine
| | - Ten Saita
- Division of Cardiovascular Medicine and Coronary Heart Disease, Hyogo College of Medicine
| | - Rika Kawakami
- Department of Surgical Pathology, Hyogo College of Medicine
| | - Kojiro Miki
- Division of Cardiovascular Medicine and Coronary Heart Disease, Hyogo College of Medicine
| | - Hiroto Tamaru
- Division of Cardiovascular Medicine and Coronary Heart Disease, Hyogo College of Medicine
| | - Tetsuo Horimatsu
- Division of Cardiovascular Medicine and Coronary Heart Disease, Hyogo College of Medicine
| | - Akinori Sumiyoshi
- Division of Cardiovascular Medicine and Coronary Heart Disease, Hyogo College of Medicine
| | - Machiko Nishimura
- Division of Cardiovascular Medicine and Coronary Heart Disease, Hyogo College of Medicine
| | - Seiichi Hirota
- Department of Surgical Pathology, Hyogo College of Medicine
| | - Tohru Masuyama
- Division of Cardiovascular Medicine and Coronary Heart Disease, Hyogo College of Medicine
| | - Masaharu Ishihara
- Division of Cardiovascular Medicine and Coronary Heart Disease, Hyogo College of Medicine
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Uchida Y, Uchida Y, Kobayashi T, Shirai S, Hiruta N, Shimoyama E, Tabata T. Detection of Ceramide, a Risk Factor for Coronary Artery Disease, in Human Coronary Plaques by Fluorescent Angioscopy. Circ J 2017; 81:1886-1893. [PMID: 28674269 DOI: 10.1253/circj.cj-17-0363] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2024]
Abstract
BACKGROUND The presence of ceramide in human coronary plaques is a risk factor for ischemic heart disease, but its visualization in the human vessel wall is currently beyond the scope of any available imaging techniques. METHODS AND RESULTS Deposition of ceramide was examined by fluorescent angioscopy (FA) and microscopy (FM) using golden fluorescence (Go) as a specific marker of ceramide in yellow plaques, which were obtained from 23 autopsy subjects and classified by conventional angioscopy and histology. Ceramide was observed by FM in 34 of the 41 yellow plaques with a necrotic core (NC) but rarely in the 28 without. Ceramide and macrophages/foam cells co-deposited mainly in the border zone of the NC and fibrous cap (FC). The Go of ceramide was seen when the fibrous cap thickness was ≤100 µm. FA was performed to detect coronary plaques exhibiting Go in patients with coronary artery disease. Ceramide was also detected by FA in 6 of 18 yellow plaques (33.3%) in 8 patients with stable angina and in 18 of 24 yellow plaques (75.0%, P<0.05 vs. stable angina) in 8 patients with old myocardial infarction. CONCLUSIONS The Go of ceramide in human coronary plaques is detectable by FA and Go could be used as a marker of vulnerable plaque (i.e., thin FC with NC).
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Affiliation(s)
| | | | | | | | - Nobuyuki Hiruta
- Department of Pathology, Toho University Medical Center Sakura Hospital
| | - Ei Shimoyama
- Department of Pathology, Funabashi-Futawa Hospital
| | - Tsuyoshi Tabata
- Department of Clinical Physiology, Toho University Medical Center Sakura Hospital
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Yonetsu T, Jang IK. Advances in Intravascular Imaging: New Insights into the Vulnerable Plaque from Imaging Studies. Korean Circ J 2017; 48:1-15. [PMID: 29171202 PMCID: PMC5764866 DOI: 10.4070/kcj.2017.0182] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 09/26/2017] [Accepted: 10/09/2017] [Indexed: 11/11/2022] Open
Abstract
The term “vulnerable plaque” denotes the plaque characteristics that are susceptible to coronary thrombosis. Previous post-mortem studies proposed 3 major mechanisms of coronary thrombosis: plaque rupture, plaque erosion, and calcified nodules. Of those, characteristics of rupture-prone plaque have been extensively studied. Pathology studies have identified the features of rupture-prone plaque including thin fibrous cap, large necrotic core, expansive vessel remodeling, inflammation, and neovascularization. Intravascular imaging modalities have emerged as adjunctive tools of angiography to identify vulnerable plaques. Multiple devices have been introduced to catheterization laboratories to date, including intravascular ultrasound (IVUS), virtual-histology IVUS, optical coherence tomography (OCT), coronary angioscopy, and near-infrared spectroscopy. With the use of these modalities, our understanding of vulnerable plaque has rapidly grown over the past several decades. One of the goals of intravascular imaging is to better predict and prevent future coronary events, for which prospective observational data is still lacking. OCT delineates microstructures of plaques, whereas IVUS visualizes macroscopic vascular structures. Specifically, plaque erosion, which has been underestimated in clinical practice, is gaining an interest due to the potential of OCT to make an in vivo diagnosis. Another potential future avenue for intravascular imaging is its use to guide treatment. Feasibility of tailored therapy for acute coronary syndromes (ACS) guided by OCT is under investigation. If it is proven to be effective, it may potentially lead to major shift in the management of millions of patients with ACS every year.
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Affiliation(s)
- Taishi Yonetsu
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Ik Kyung Jang
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Division of Cardiology, Kyung-Hee University Hospital, Seoul, Korea.
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14
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The Future of Intravascular Imaging: Are We Primed to Detect Vulnerable Plaques? CURRENT CARDIOVASCULAR IMAGING REPORTS 2017. [DOI: 10.1007/s12410-017-9407-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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15
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Sugiyama T, Jang IK. Optical Coherence Tomography for Study of In Vivo Pathobiology and for Optimization of Percutaneous Coronary Intervention. ACTA ACUST UNITED AC 2017. [DOI: 10.15791/angioscopy.re.17.0020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Tomoyo Sugiyama
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School
| | - Ik-Kyung Jang
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School
- Division of Cardiology, Kyung Hee University Hospital
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16
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Kurihara O, Takano M, Mizuno K, Shibata Y, Matsushita M, Komiyama H, Yamamoto M, Kato K, Munakata R, Murakami D, Okamatsu K, Hata N, Seino Y, Shimizu W. Impact of Diabetic Retinopathy on Vulnerability of Atherosclerotic Coronary Plaque and Incidence of Acute Coronary Syndrome. Am J Cardiol 2016; 118:944-949. [PMID: 27530826 DOI: 10.1016/j.amjcard.2016.06.060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 06/30/2016] [Accepted: 06/30/2016] [Indexed: 10/21/2022]
Abstract
Although an association has been reported between the microvascular complications of diabetic patients and their poor prognosis after cardiovascular events related to advanced atherosclerosis, it is not clear whether there is a relation between diabetic retinopathy (DR) and the severity of plaque vulnerability. Fifty-seven diabetic patients with coronary artery disease, classified as non-DR (n = 42) or DR (n = 15), underwent angioscopic observation of at least 1 entire coronary artery. The number of yellow plaques (NYP) through the observed coronary artery was counted and their color grades, defined as 1 (light yellow), 2 (yellow), or 3 (intense yellow), were evaluated. The NYP per vessel and the maximum yellow grade were determined. The association between the presence of DR and incidences of acute coronary syndrome (ACS) was analyzed during the follow-up period (mean 7.1 ± 3.3 years; range, 0.83 to 11.75 years). Mean NYP per vessel and maximum yellow grade were significantly greater in DR than in non-DR patients (2.08 ± 1.01 vs 1.26 ± 0.77, p = 0.002, and 2.40 ± 0.74 vs 1.90 ± 0.82, p = 0.044, respectively). The cumulative incidences of ACS were higher in the DR group (p = 0.004), and the age-adjusted hazard ratio for ACS was 6.943 (95% CI 1.267 to 38.054; p = 0.026) for DR compared with non-DR patients. Our findings indicate that coronary atherosclerosis and plaque vulnerability are more severe in patients with DR. DR as a microvascular complication may be directly linked with macrovascular plaque vulnerability and fatal cardiovascular events such as ACS.
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Affiliation(s)
- Osamu Kurihara
- Cardiovascular Center, Nippon Medical School Chiba-Hokusoh Hospital, Chiba, Japan
| | - Masamichi Takano
- Cardiovascular Center, Nippon Medical School Chiba-Hokusoh Hospital, Chiba, Japan.
| | - Kyoichi Mizuno
- Division of Cardiology, Nippon Medical School, Tokyo, Japan
| | - Yusaku Shibata
- Cardiovascular Center, Nippon Medical School Chiba-Hokusoh Hospital, Chiba, Japan
| | - Masato Matsushita
- Cardiovascular Center, Nippon Medical School Chiba-Hokusoh Hospital, Chiba, Japan
| | - Hidenori Komiyama
- Cardiovascular Center, Nippon Medical School Chiba-Hokusoh Hospital, Chiba, Japan
| | - Masanori Yamamoto
- Cardiovascular Center, Nippon Medical School Chiba-Hokusoh Hospital, Chiba, Japan
| | - Katsuhito Kato
- Cardiovascular Center, Nippon Medical School Chiba-Hokusoh Hospital, Chiba, Japan
| | - Ryo Munakata
- Cardiovascular Center, Nippon Medical School Chiba-Hokusoh Hospital, Chiba, Japan
| | - Daisuke Murakami
- Cardiovascular Center, Nippon Medical School Chiba-Hokusoh Hospital, Chiba, Japan
| | - Kentaro Okamatsu
- Cardiovascular Center, Nippon Medical School Chiba-Hokusoh Hospital, Chiba, Japan
| | - Noritake Hata
- Cardiovascular Center, Nippon Medical School Chiba-Hokusoh Hospital, Chiba, Japan
| | - Yoshihiko Seino
- Cardiovascular Center, Nippon Medical School Chiba-Hokusoh Hospital, Chiba, Japan
| | - Wataru Shimizu
- Division of Cardiology, Nippon Medical School, Tokyo, Japan
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17
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Kimura S, Sugiyama T, Hishikari K, Nakamura S, Nakagama S, Misawa T, Mizusawa M, Hayasaka K, Yamakami Y, Sagawa Y, Kojima K, Ohtani H, Hikita H, Takahashi A, Isobe M. Impact of optical coherence tomography- and coronary angioscopy-assessed neointimal tissue characteristics on occurrence of periprocedural myonecrosis in patients with in-stent restenosis. Int J Cardiovasc Imaging 2016; 32:1483-94. [PMID: 27423209 DOI: 10.1007/s10554-016-0941-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 07/13/2016] [Indexed: 12/21/2022]
Abstract
Several characteristics of neointimal tissues, including neoatherosclerotic progression, have been reported in lesions with in-stent restenosis (ISR). However, the effects of these characteristics on outcomes after percutaneous coronary intervention (PCI) for ISR lesions remain unclear. We assessed the relationships between neointimal tissue characteristics and the occurrence of periprocedural myonecrosis (PMN) after PCI in ISR lesions. We investigated 72 ISR lesions in 72 patients with stable angina pectoris (SAP) who underwent pre- and post-revascularization optical coherence tomography (OCT) and coronary angioscopy (CAS). All lesions were classified as with PMN, defined by an elevated peak high-sensitivity cardiac troponin-T level during the 24-h post-PCI period, and without PMN. PMN was observed in 23 (31.9 %) lesions. PMN lesions had higher frequencies of OCT-derived thin-cap fibroatheroma (26.1 vs. 6.1 %, P = 0.03), CAS-derived intensive yellow neointima (30.4 vs. 10.2 %, P = 0.04), neointima with complex surface (60.9 vs. 28.6 %, P = 0.01), and CAS-derived atheromatous appearance (CAS-AAP), defined as yellow plaque including complex thrombi underneath disrupted neointimal coverage after ballooning (47.8 vs. 16.3 %, P = 0.008) at the most stenotic sites inside stents, compared to lesions without PMN. Multivariate logistic regression analysis identified CAS-AAP (odds ratio: 3.568, 95 % confidence interval: 1.109-11.475, P = 0.033) as an independent predictor of PMN. For ISR lesions in SAP patients, an OCT- and CAS-based assessment of neointimal tissue characteristics might help to predict the occurrence of PMN.
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Affiliation(s)
- Shigeki Kimura
- Cardiovascular Center, Yokosuka Kyosai Hospital, 1-16 Yonegahamadori, Yokosuka, Kanagawa, 238-8558, Japan.
| | - Tomoyo Sugiyama
- Cardiovascular Center, Yokosuka Kyosai Hospital, 1-16 Yonegahamadori, Yokosuka, Kanagawa, 238-8558, Japan
| | - Keiichi Hishikari
- Cardiovascular Center, Yokosuka Kyosai Hospital, 1-16 Yonegahamadori, Yokosuka, Kanagawa, 238-8558, Japan
| | - Shun Nakamura
- Cardiovascular Center, Yokosuka Kyosai Hospital, 1-16 Yonegahamadori, Yokosuka, Kanagawa, 238-8558, Japan
| | - Shun Nakagama
- Cardiovascular Center, Yokosuka Kyosai Hospital, 1-16 Yonegahamadori, Yokosuka, Kanagawa, 238-8558, Japan
| | - Toru Misawa
- Cardiovascular Center, Yokosuka Kyosai Hospital, 1-16 Yonegahamadori, Yokosuka, Kanagawa, 238-8558, Japan
| | - Masafumi Mizusawa
- Cardiovascular Center, Yokosuka Kyosai Hospital, 1-16 Yonegahamadori, Yokosuka, Kanagawa, 238-8558, Japan
| | - Kazuto Hayasaka
- Cardiovascular Center, Yokosuka Kyosai Hospital, 1-16 Yonegahamadori, Yokosuka, Kanagawa, 238-8558, Japan
| | - Yosuke Yamakami
- Cardiovascular Center, Yokosuka Kyosai Hospital, 1-16 Yonegahamadori, Yokosuka, Kanagawa, 238-8558, Japan
| | - Yuichiro Sagawa
- Cardiovascular Center, Yokosuka Kyosai Hospital, 1-16 Yonegahamadori, Yokosuka, Kanagawa, 238-8558, Japan
| | - Keisuke Kojima
- Cardiovascular Center, Yokosuka Kyosai Hospital, 1-16 Yonegahamadori, Yokosuka, Kanagawa, 238-8558, Japan
| | - Hirofumi Ohtani
- Cardiovascular Center, Yokosuka Kyosai Hospital, 1-16 Yonegahamadori, Yokosuka, Kanagawa, 238-8558, Japan
| | - Hiroyuki Hikita
- Cardiovascular Center, Yokosuka Kyosai Hospital, 1-16 Yonegahamadori, Yokosuka, Kanagawa, 238-8558, Japan
| | - Atsushi Takahashi
- Cardiovascular Center, Yokosuka Kyosai Hospital, 1-16 Yonegahamadori, Yokosuka, Kanagawa, 238-8558, Japan
| | - Mitsuaki Isobe
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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18
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Ex vivo comparison of angioscopy and histopathology for the evaluation of coronary plaque characteristics. Int J Cardiovasc Imaging 2016; 32:863-9. [DOI: 10.1007/s10554-016-0855-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 02/08/2016] [Indexed: 11/25/2022]
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19
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Coronary atherosclerosis and risk of acute coronary syndromes in chronic kidney disease using angioscopy and the kidney disease: Improving Global Outcomes (KDIGO) classification. Atherosclerosis 2015; 243:567-72. [DOI: 10.1016/j.atherosclerosis.2015.10.094] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 10/21/2015] [Accepted: 10/22/2015] [Indexed: 11/20/2022]
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20
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Komiyama H, Takano M, Hata N, Seino Y, Shimizu W, Mizuno K. Neoatherosclerosis: Coronary stents seal atherosclerotic lesions but result in making a new problem of atherosclerosis. World J Cardiol 2015; 7:776-783. [PMID: 26635925 PMCID: PMC4660472 DOI: 10.4330/wjc.v7.i11.776] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 07/21/2015] [Accepted: 09/16/2015] [Indexed: 02/06/2023] Open
Abstract
Chronic inflammation of the native vessel wall with infiltration of lipid-laden foamy macrophages through impaired endothelium results in atherosclerosis. Percutaneous coronary intervention, including metallic stent implantation, is now widely utilized for the treatment of atherosclerotic lesions of the coronary artery. Bare-metal stents and the subsequently developed drug-eluting stents seal the atherosclerosis and resolve lumen stenosis or obstruction of the epicardial coronary artery and myocardial ischemia. After stent implantation, neointima proliferates within the stented segment. Chronic inflammation caused by a foreign body reaction to the implanted stent and subsequent neovascularization, which is characterized by the continuous recruitment of macrophages into the vessel, result in the transformation of the usual neointima into an atheromatous neointima. Neointima with an atherosclerotic appearance, such as that caused by thin-cap fibroatheromas, is now recognized as neoatherosclerosis, which can sometimes cause in-stent restenosis and acute thrombotic occlusion originating from the stent segment following disruption of the atheroma. Neoatherosclerosis is emerging as a new coronary stent-associated problem that has not yet been resolved. In this review article, we will discuss possible mechanisms, clinical challenges, and the future outlook of neoatherosclerosis.
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Affiliation(s)
- Hidenori Komiyama
- Hidenori Komiyama, Masamichi Takano, Noritake Hata, Yoshihiko Seino, Cardiovascular Center, Chiba Hokusou Hospital, Nippon Medical School, Chiba 270-1613, Japan
| | - Masamichi Takano
- Hidenori Komiyama, Masamichi Takano, Noritake Hata, Yoshihiko Seino, Cardiovascular Center, Chiba Hokusou Hospital, Nippon Medical School, Chiba 270-1613, Japan
| | - Noritake Hata
- Hidenori Komiyama, Masamichi Takano, Noritake Hata, Yoshihiko Seino, Cardiovascular Center, Chiba Hokusou Hospital, Nippon Medical School, Chiba 270-1613, Japan
| | - Yoshihiko Seino
- Hidenori Komiyama, Masamichi Takano, Noritake Hata, Yoshihiko Seino, Cardiovascular Center, Chiba Hokusou Hospital, Nippon Medical School, Chiba 270-1613, Japan
| | - Wataru Shimizu
- Hidenori Komiyama, Masamichi Takano, Noritake Hata, Yoshihiko Seino, Cardiovascular Center, Chiba Hokusou Hospital, Nippon Medical School, Chiba 270-1613, Japan
| | - Kyoichi Mizuno
- Hidenori Komiyama, Masamichi Takano, Noritake Hata, Yoshihiko Seino, Cardiovascular Center, Chiba Hokusou Hospital, Nippon Medical School, Chiba 270-1613, Japan
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21
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Extreme late-phase observation using coronary angioscopy until 7 years after sirolimus-eluting stent implantation. Coron Artery Dis 2015; 27:29-33. [PMID: 26513292 DOI: 10.1097/mca.0000000000000315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Little is known about the very late-phase morphological vessel characteristics within the sirolimus-eluting stent (SES). METHODS AND RESULTS We assessed a total of 12 patients with 15 SES implantations who underwent repeat angiographic and angioscopic procedures after 5 and 7 years. The degree of neointimal stent coverage (NSC) was classified as follows: grade 0, uncovered struts; grade 1, visible struts through a thin neointima; or grade 2, invisible struts with complete neointimal coverage. The maximum and minimum NSC grades were evaluated and the existence of in-stent thrombus was also recorded for all patients. The prevalence of a maximum NSC grade of 2 increased and that of a minimum NSC grade of 0 decreased, although there was no significant difference in prevalence between 5 and 7 years. One of four in-stent thrombus identified at 5 years had disappeared from 5 to 7 years and a new thrombus was found in another patient at 7 years. Thus, the incidence of in-stent thrombus did not change from 5 to 7 years. In one case, a thrombus was observed inside the angiographic aneurysmal change, but none of the thrombi were related to adverse events. CONCLUSION This angioscopic study reported gradual arterial repair and continuous delayed healing associated with subclinical thrombus formation 7 years after SES deployment.
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22
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Roleder T, Kovacic JC, Ali Z, Sharma R, Cristea E, Moreno P, Sharma SK, Narula J, Kini AS. Combined NIRS and IVUS imaging detects vulnerable plaque using a single catheter system: a head-to-head comparison with OCT. EUROINTERVENTION 2015; 10:303-11. [PMID: 24769522 DOI: 10.4244/eijv10i3a53] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The presence of thin-cap fibroatheromas (TCFA) is associated with high risk of acute coronary syndrome, hence their early detection may identify high-risk patients. In the present study we investigated the ability of a combined imaging catheter with near-infrared spectroscopy (NIRS) plus intravascular ultrasound (IVUS) to detect TCFA in patients with stable coronary artery disease. METHODS AND RESULTS Optical coherence tomography (OCT) and combined NIRS-IVUS assessment were performed on identical coronary segments. IVUS analysis provided per-segment minimal cross-sectional area (CSA), plaque length (PL), plaque burden (PB), plaque volume (PV), and remodelling index (RI). OCT was used as the gold-standard reference to define TCFA (fibrous cap thickness <65 μm). Plaque lipid content was estimated by NIRS (lipid core burden index [LCBI]). OCT-defined TCFA was present in 18 of 76 segments. IVUS revealed that OCT-defined TCFA were positively remodelled lesions with greater PB and PV, smaller CSA, and longer PL, while NIRS revealed greater LCBI per 2 mm segment (LCBI2mm) (all p<0.001). Greatest accuracy for OCT-defined TCFA detection was achieved using LCBI2mm >315 with RI >1.046 as a combined criterion value. CONCLUSIONS OCT-defined TCFA are characterised by positive vessel remodelling, high plaque burden and greater lipid core burden as assessed by dual NIRS-IVUS imaging.
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Affiliation(s)
- Tomasz Roleder
- Mount Sinai Medical Center and Mount Sinai School of Medicine, New York, NY, USA
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23
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Kurihara O, Takano M, Seino Y, Shimizu W, Mizuno K. Coronary atherosclerosis is already ongoing in pre-diabetic status: Insight from intravascular imaging modalities. World J Diabetes 2015; 6:184-191. [PMID: 25685289 PMCID: PMC4317311 DOI: 10.4239/wjd.v6.i1.184] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 10/22/2014] [Accepted: 12/16/2014] [Indexed: 02/05/2023] Open
Abstract
Diabetes mellitus is a powerful risk factor of coronary artery disease (CAD), leading to death and disability. In recent years, given the accumulating evidence that prediabetes is also related to increasing risk of CAD including cardiovascular events, a new guideline has been proposed for the treatment of blood cholesterol for primary prevention of cardiovascular events. This guideline recommends aggressive lipid-lowering statin therapy for primary prevention in diabetes and other patients. The ultimate goal of patient management is to inhibit progression of systemic atherosclerosis and prevent fatal cardiovascular events such as acute coronary syndrome (ACS). Because disruption of atherosclerotic coronary plaques is a trigger of ACS, the high-risk atheroma is called a vulnerable plaque. Several types of novel diagnostic imaging technologies have been developed for identifying the characteristics of coronary atherosclerosis before the onset of ACS, especially vulnerable plaques. According to coronary angioscopic evaluation, atherosclerosis severity and plaque vulnerability were more advanced in prediabetic than in nondiabetic patients and comparable to that in diabetic patients. In addition, pharmacological intervention by statin therapy changed plaque color and complexity, and the dynamic changes in plaque features are considered plaque stabilization. In this article, we review the findings of atherosclerosis in prediabetes, detected by intravascular imaging modalities, and the therapeutic implications.
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24
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Nonangiographic assessment of coronary artery disease: a practical approach to optical coherence tomography and fractional flow reserve. Coron Artery Dis 2014; 25:608-18. [PMID: 25203101 DOI: 10.1097/mca.0000000000000173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
In an era of increased scrutiny of the appropriateness and safety of revascularization, interventional cardiologists must evolve by adding key tools to their armamentarium. This review highlights the utility of optical coherence tomography and fractional flow reserve in the catheterization lab and provides a practical guide for using these technologies during coronary intervention in various lesion subsets. We propose that fractional flow reserve informs the decision to intervene and optical coherence tomography guides the optimization of the outcome.
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25
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Sanchez OD, Sakakura K, Otsuka F, Yahagi K, Virmani R, Joner M. Expectations and limitations of contemporary intravascular imaging: lessons learned from pathology. Expert Rev Cardiovasc Ther 2014; 12:601-11. [PMID: 24738595 DOI: 10.1586/14779072.2014.902749] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Acute coronary syndrome is the leading cause of death worldwide and plaque rupture is the most common underlying mechanism of coronary thrombosis. During the last 2 decades the understanding of atherosclerotic plaque progression advanced dramatically and pathology studies provided fundamental insights of underlying plaque morphology, which paved the way for invasive imaging modalities, which bring a new area of atherosclerotic plaque characterization in vivo. The development of intravascular ultrasound (IVUS) allowed the field to evaluate the principles of vascular anatomy, which is often underestimated by coronary angiography. Furthermore, IVUS image technologies were developed to obtain improved characterization of plaque composition. However, since spatial resolution of IVUS is insufficient to distinguish details of plaque morphology, a broad adoption of this technology in clinical practice was missing. Optical coherence tomography is a light-based imaging modality with higher spatial resolution compared to IVUS, which enables the assessment of vascular anatomy with great detail.
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26
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Ono K. Seeing is believing - Imaging of a plaque in the renal artery. J Cardiol Cases 2014; 9:84-85. [PMID: 30534303 PMCID: PMC6277988 DOI: 10.1016/j.jccase.2013.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Indexed: 11/22/2022] Open
Affiliation(s)
- Koh Ono
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
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27
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Fenning RS, Wilensky RL. New Insights into the Vulnerable Plaque from Imaging Studies. Curr Atheroscler Rep 2014; 16:397. [DOI: 10.1007/s11883-014-0397-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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28
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Identification of high-risk plaques associated with peri-procedural myocardial injury following elective percutaneous coronary intervention: Assessment by high-sensitivity troponin-T measurements and optical coherence tomography. Int J Cardiol 2013; 168:2860-2. [DOI: 10.1016/j.ijcard.2013.03.134] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Accepted: 03/28/2013] [Indexed: 11/22/2022]
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29
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Dixon AJ, Hossack JA. Intravascular near-infrared fluorescence catheter with ultrasound guidance and blood attenuation correction. JOURNAL OF BIOMEDICAL OPTICS 2013; 18:56009. [PMID: 23698320 PMCID: PMC3650865 DOI: 10.1117/1.jbo.18.5.056009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Revised: 04/05/2013] [Accepted: 04/08/2013] [Indexed: 05/19/2023]
Abstract
Intravascular near-infrared fluorescence (NIRF) imaging offers a new approach for characterizing atherosclerotic plaque, but random catheter positioning within the vessel lumen results in variable light attenuation and can yield inaccurate measurements. We hypothesized that NIRF measurements could be corrected for variable light attenuation through blood by tracking the location of the NIRF catheter with intravascular ultrasound (IVUS). In this study, a combined NIRF-IVUS catheter was designed to acquire coregistered NIRF and IVUS data, an automated image processing algorithm was developed to measure catheter-to-vessel wall distances, and depth-dependent attenuation of the fluorescent signal was corrected by an analytical light propagation model. Performance of the catheter sensing distance correction method was evaluated in coronary artery phantoms and ex vivo arteries. The correction method produced NIRF estimates of fluorophore concentrations, in coronary artery phantoms, with an average root mean square error of 17.5%. In addition, the correction method resulted in a statistically significant improvement in correlation between spatially resolved NIRF measurements and known fluorophore spatial distributions in ex vivo arteries (from r = 0.24 to 0.69, p < 0.01, n = 6). This work demonstrates that catheter-to-vessel wall distances, measured from IVUS images, can be employed to compensate for inaccuracies caused by variable intravascular NIRF sensing distances.
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Affiliation(s)
- Adam J Dixon
- University of Virginia, Department of Biomedical Engineering, Charlottesville, VA 22908, USA.
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30
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Kurihara O, Takano M, Kobayashi N, Yamamoto M, Seino Y, Mizuno K. Deceived incidence of acute coronary syndrome by measurement of FFR: Diagnostic gap of vulnerable plaque between physiology and morphology. J Cardiol Cases 2013; 8:e7-e8. [PMID: 30546728 DOI: 10.1016/j.jccase.2013.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 02/19/2013] [Accepted: 02/26/2013] [Indexed: 12/01/2022] Open
Abstract
A 67-year-old male was admitted because of acute myocardial infarction (AMI). An emergent coronary angiography showed a total occlusion in the left anterior descending artery, and a stent was deployed. Moderate lesion stenosis was found in the right coronary artery (RCA). Fractional flow reserve indicated 0.96, and percutaneous coronary intervention was not performed. Six months later, the patient visited an emergency room due to AMI. Angiograms showed a patency of the previous stent and progressed stenosis with filling delay of the RCA. Protruding red thrombi and plaque disruption of thin-cap fibroatheroma (TCFA) were identified by optical coherence tomography. Mild to moderate lesions are physiologically benign but morphologically malignant in cases of TCFA. <Learning objective: Severe stenosis is a malignant index of plaque vulnerability on the basis of physiological and morphological evaluation. However, mild to moderate lesions are physiologically benign but morphologically malignant in cases of thin-cap fibroatheroma. Although fractional flow reserve can estimate the extent of severe stenosis, one of the elements of vulnerable plaques, it cannot always predict future events related to morphologically vulnerable plaques>.
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Affiliation(s)
- Osamu Kurihara
- Cardiovascular Center, Chiba-Hokusoh Hospital, Nippon Medical School, 1715 Kamakari, Inzai, Chiba 270-1694, Japan
| | - Masamichi Takano
- Cardiovascular Center, Chiba-Hokusoh Hospital, Nippon Medical School, 1715 Kamakari, Inzai, Chiba 270-1694, Japan
| | - Nobuaki Kobayashi
- Cardiovascular Center, Chiba-Hokusoh Hospital, Nippon Medical School, 1715 Kamakari, Inzai, Chiba 270-1694, Japan
| | - Masanori Yamamoto
- Cardiovascular Center, Chiba-Hokusoh Hospital, Nippon Medical School, 1715 Kamakari, Inzai, Chiba 270-1694, Japan
| | - Yoshihiko Seino
- Cardiovascular Center, Chiba-Hokusoh Hospital, Nippon Medical School, 1715 Kamakari, Inzai, Chiba 270-1694, Japan
| | - Kyoichi Mizuno
- Division of Cardiology, Nippon Medical School, Tokyo, Japan
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31
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Kurihara O, Takano M, Yamamoto M, Shirakabe A, Kimata N, Inami T, Kobayashi N, Munakata R, Murakami D, Inami S, Okamatsu K, Ohba T, Ibuki C, Hata N, Seino Y, Mizuno K. Impact of prediabetic status on coronary atherosclerosis: a multivessel angioscopic study. Diabetes Care 2013; 36:729-733. [PMID: 23223344 PMCID: PMC3579367 DOI: 10.2337/dc12-1635] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 09/17/2012] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine if prediabetes is associated with atherosclerosis of coronary arteries, we evaluated the degree of coronary atherosclerosis in nondiabetic, prediabetic, and diabetic patients by using coronary angioscopy to identify plaque vulnerability based on yellow color intensity. RESEARCH DESIGN AND METHODS Sixty-seven patients with coronary artery disease (CAD) underwent angioscopic observation of multiple main-trunk coronary arteries. According to the American Diabetes Association guidelines, patients were divided into nondiabetic (n = 16), prediabetic (n = 28), and diabetic (n = 23) groups. Plaque color grade was defined as 1 (light yellow), 2 (yellow), or 3 (intense yellow) based on angioscopic findings. The number of yellow plaques (NYPs) per vessel and maximum yellow grade (MYG) were compared among the groups. RESULTS Mean NYP and MYG differed significantly between the groups (P = 0.01 and P = 0.047, respectively). These indexes were higher in prediabetic than in nondiabetic patients (P = 0.02 and P = 0.04, respectively), but similar in prediabetic and diabetic patients (P = 0.44 and P = 0.21, respectively). Diabetes and prediabetes were independent predictors of multiple yellow plaques (NYPs ≥2) in multivariate logistic regression analysis (odds ratio [OR] 10.8 [95% CI 2.09-55.6], P = 0.005; and OR 4.13 [95% CI 1.01-17.0], P = 0.049, respectively). CONCLUSIONS Coronary atherosclerosis and plaque vulnerability were more advanced in prediabetic than in nondiabetic patients and comparable between prediabetic and diabetic patients. Slight or mild disorders in glucose metabolism, such as prediabetes, could be a risk factor for CAD, as is diabetes itself.
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Affiliation(s)
- Osamu Kurihara
- Cardiovascular Center, Chiba-Hokusoh Hospital, Nippon Medical School, Chiba, Japan
| | - Masamichi Takano
- Cardiovascular Center, Chiba-Hokusoh Hospital, Nippon Medical School, Chiba, Japan
| | - Masanori Yamamoto
- Cardiovascular Center, Chiba-Hokusoh Hospital, Nippon Medical School, Chiba, Japan
| | - Akihiro Shirakabe
- Cardiovascular Center, Chiba-Hokusoh Hospital, Nippon Medical School, Chiba, Japan
| | - Nakahisa Kimata
- Cardiovascular Center, Chiba-Hokusoh Hospital, Nippon Medical School, Chiba, Japan
| | - Toru Inami
- Cardiovascular Center, Chiba-Hokusoh Hospital, Nippon Medical School, Chiba, Japan
| | - Nobuaki Kobayashi
- Cardiovascular Center, Chiba-Hokusoh Hospital, Nippon Medical School, Chiba, Japan
| | - Ryo Munakata
- Cardiovascular Center, Chiba-Hokusoh Hospital, Nippon Medical School, Chiba, Japan
| | - Daisuke Murakami
- Cardiovascular Center, Chiba-Hokusoh Hospital, Nippon Medical School, Chiba, Japan
| | - Shigenobu Inami
- Cardiovascular Center, Chiba-Hokusoh Hospital, Nippon Medical School, Chiba, Japan
| | - Kentaro Okamatsu
- Cardiovascular Center, Chiba-Hokusoh Hospital, Nippon Medical School, Chiba, Japan
| | - Takayoshi Ohba
- Cardiovascular Center, Chiba-Hokusoh Hospital, Nippon Medical School, Chiba, Japan
| | - Chikao Ibuki
- Cardiovascular Center, Chiba-Hokusoh Hospital, Nippon Medical School, Chiba, Japan
| | - Noritake Hata
- Cardiovascular Center, Chiba-Hokusoh Hospital, Nippon Medical School, Chiba, Japan
| | - Yoshihiko Seino
- Cardiovascular Center, Chiba-Hokusoh Hospital, Nippon Medical School, Chiba, Japan
| | - Kyoichi Mizuno
- Division of Cardiology, Nippon Medical School, Tokyo, Japan
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32
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Davlouros PA, Mavronasiou E, Xanthopoulou I, Karantalis V, Tsigkas G, Hahalis G, Alexopoulos D. An optical coherence tomography study of two new generation stents with biodegradable polymer carrier, eluting paclitaxel vs. biolimus-A9. Int J Cardiol 2012; 157:341-6. [DOI: 10.1016/j.ijcard.2010.12.072] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Accepted: 12/20/2010] [Indexed: 11/15/2022]
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Miyamoto Y, Okura H, Kume T, Kawamoto T, Neishi Y, Hayashida A, Yamada R, Imai K, Saito K, Yoshida K. Plaque characteristics of thin-cap fibroatheroma evaluated by OCT and IVUS. JACC Cardiovasc Imaging 2012; 4:638-46. [PMID: 21679899 DOI: 10.1016/j.jcmg.2011.03.014] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2010] [Revised: 03/02/2011] [Accepted: 03/10/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The purpose of this study was to assess plaque characteristics of optical coherence tomography (OCT)-derived thin-cap fibroatheroma (TCFA) by integrated backscatter intravascular ultrasound (IB-IVUS). BACKGROUND Radiofrequency signal-derived IVUS tissue characterization technology has become clinically available and provided objective and quantitative plaque characteristics of the coronary vessel wall. Integrated backscatter IVUS is one of the tissue characterization methods that can possibly provide quantitative plaque characteristics of the OCT-derived TCFA. METHODS Eighty-one coronary lesions with plaque burden >40% were selected and analyzed with both IB-IVUS and OCT. The OCT-derived TCFA was defined as a presence of thin fibrous cap (<65 μm) overlying a signal-poor lesion with diffuse border representing a lipid-rich plaque. By conventional gray-scale IVUS, external elastic membrane (EEM) cross-sectional area (CSA), lumen CSA, plaque plus media (P+M) CSA, plaque burden and remodeling index were measured. By IB-IVUS, plaque characteristics were further classified as fibrosis, dense fibrosis, calcification, or lipid pool. RESULTS Optical coherence tomography identified 40 TCFAs (49%) and 41 non-TCFAs. The EEM CSA, P+M CSA, plaque burden, and remodeling index were significantly larger in OCT-derived TCFA than non-TCFA. By IB-IVUS, percentage lipid pool area (= lipid pool area/P+M CSA × 100) was significantly higher (62.4 ± 12.8% vs. 38.4 ± 13.1%, p<0.0001) and percentage fibrosis area (= fibrosis area/P+M CSA × 100) was significantly lower (34.6 ± 11.4% vs. 50.5 ± 8.7%, p<0.0001) in OCT-derived TCFA than non-TCFA. By receiver-operator characteristic curve analysis, percentage lipid pool area ≥55%, percentage fibrosis area ≤41%, and remodeling index ≥1.0 were predictors of OCT-derived TCFA. CONCLUSIONS The OCT-derived TCFA had larger plaque burden and positive remodeling with predominant lipid component and less fibrous plaque assessed by IB-IVUS.
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Hattori K, Ozaki Y, Ismail TF, Okumura M, Naruse H, Kan S, Ishikawa M, Kawai T, Ohta M, Kawai H, Hashimoto T, Takagi Y, Ishii J, Serruys PW, Narula J. Impact of Statin Therapy on Plaque Characteristics as Assessed by Serial OCT, Grayscale and Integrated Backscatter–IVUS. JACC Cardiovasc Imaging 2012; 5:169-77. [DOI: 10.1016/j.jcmg.2011.11.012] [Citation(s) in RCA: 156] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Revised: 10/18/2011] [Accepted: 11/27/2011] [Indexed: 12/29/2022]
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Yang XS, Zhu HG, Yu ZJ, Ren F, Chen YQ, Wu X, Zhang ZC, Zhang LJ, Lu SZ. The union of anti-CD34 antibody can improve the performance of drug-eluting stents. Catheter Cardiovasc Interv 2011; 79:972-8. [PMID: 22162277 DOI: 10.1002/ccd.23186] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Accepted: 03/26/2011] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The authors investigate whether the combination of anti-CD34 antibody with DES is win-win cooperation. BACKGROUND DES may reduce the risk of restenosis compared to bare-metal stents (BMS), but they were found to inhibit the healing process of intima. METHODS Fifteen BMS, 17 DES, and 16 combined anti-CD34 antibody and DES were randomly implanted in the coronary arteries of 22 minipigs. Ten minipigs were followed up to 2 weeks. The stenting coronary segments were examined by histological examination and scanning electron microscopy after in vivo coronary angiography and intracoronary optical coherence tomography (OCT) examinations. The other 12 minipigs were followed up to 3 months. Coronary angiography and intracoronary OCT examination were performed in vivo and histological examination was performed on the stenting coronary segments. RESULTS After 2 weeks, the neointimal covering level of the DES was lower than that in BMS, but the covering level of the combined stents was even better than the BMS. After 3 months, neointimal hyperplasia was significant in the BMS, but not in the other two types of stents. The in-stent late lumen loss of the combined stents even showed a decreasing tendency when compared with the DES. CONCLUSION The combination of anti-CD34 antibody and DES can not only well offset the short-term inhibitory effect on re-endothelialization but also slightly enhance the long-term antiproliferative effect.
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Affiliation(s)
- Xing-Sheng Yang
- The 1st Ward of Beijing Anzhen Hospital Affiliated by Capital Medical University, Beijing 100029, China
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36
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Moulias A, Alexopoulos D. Long-term outcome of percutaneous coronary intervention: the significance of native coronary artery disease progression. Clin Cardiol 2011; 34:588-92. [PMID: 21932326 DOI: 10.1002/clc.20929] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Accepted: 05/17/2011] [Indexed: 11/09/2022] Open
Abstract
The extensive use of stents during percutaneous coronary intervention (PCI) is associated with concerns about their potential adverse effects. In-stent restenosis and stent thrombosis definitely significantly affect the PCI outcome. However, review of recent relevant studies suggests that stent-related problems may have been somewhat overestimated when compared to coronary artery disease (CAD) progression at nonstented coronary segments as causative factors of adverse cardiac clinical events late (>30 days) post-PCI. Both stent-related problems and native CAD progression have to be equally addressed to optimize the PCI clinical benefit.
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37
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Inami S, Wang Z, Ming-Juan Z, Takano M, Mizuno K. Current status of optical coherence tomography. Cardiovasc Interv Ther 2011; 26:177-85. [PMID: 24122583 DOI: 10.1007/s12928-011-0057-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Accepted: 02/06/2011] [Indexed: 11/25/2022]
Abstract
Optical coherence tomography (OCT) is a novel imaging technology based on low-coherence interferometry that use near-infrared light in real-time, and allows cross-sectional in-situ visualization of the vessel wall at the microscopic level. OCT provides 10-fold higher resolution than intravascular ultrasound which is currently the most used modality for intra-coronary imaging. OCT offers the obvious advantages when characterizing precise plaque microstructure and distinguishing various type of plaques. OCT is also being assessed for its potential role in the understanding of neointimal coverage, vascular healing and the progression of atherosclerosis in coronary vasculature after stenting on the micron scale. These unique capabilities could be helpful in guiding coronary management and interventions. Recent improvement in next generation OCT technology, such as frequency-domain OCT, will allow for a simple imaging procedure, providing more useful information and complementing other modalities on both clinical and research applications for the cardiologists.
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Affiliation(s)
- Shigenobu Inami
- Division of Cardiology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan,
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38
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Angioscopy and Unstable Coronary Plaques: Findings Beyond Thrombus. CURRENT CARDIOVASCULAR IMAGING REPORTS 2011. [DOI: 10.1007/s12410-011-9087-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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39
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Murakami D, Takano M, Yamamoto M, Inami T, Inami S, Okamatsu K, Ohba T, Seino Y, Mizuno K. Intense yellow culprit plaque coloration is closely associated with troponin-T elevation and flow complications following elective coronary stenting. J Atheroscler Thromb 2011; 18:906-13. [PMID: 21778655 DOI: 10.5551/jat.8128] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM The elevation of troponin-T (TnT) and occurrence of transient slow-flow phenomena have been recognized as procedure-related myocardial injuries. Little is known about the characteristics of high-risk plaque resulting in myocardial injury after coronary stenting. METHODS The culprit plaques in 42 consecutive patients with stable angina undergoing elective coronary stenting were observed by angioscopy. The plaque color upon angioscopic examination was classified as either intense yellow or not yellow. Slow flow was defined as < TIMI grade 3 flow during the procedure. The TnT levels were measured 8, 16, and 24 hours after stenting, and myocardial injury was defined as TnT ≥ 0.03 ng/mL at any time point. RESULTS Twenty-four patients (57%) had intense yellow plaques and myocardial injury occurred in 22 patients (52%). The frequency of intense yellow plaque was significantly higher in the patients with myocardial injury than in those without myocardial injury (91% vs. 20%, p < 0.001). Transient slow flow occurred frequently in patients with myocardial injury than in those without myocardial injury (23% vs. 0%, p = 0.049). All patients with transient slow flow had intense yellow plaques at the culprit lesions. CONCLUSIONS Intense yellow culprit plaque coloration was closely associated with TnT elevation and flow complications following elective coronary stenting. Angioscopically-observed intense yellow coloration may therefore predict high-risk plaque for peri-procedural myocardial injury.
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Affiliation(s)
- Daisuke Murakami
- Cardiovascular Center, Chiba-Hokusoh Hospital, Nippon Medical School, Chiba, Japan
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40
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Suh WM, Seto AH, Margey RJP, Cruz-Gonzalez I, Jang IK. Intravascular detection of the vulnerable plaque. Circ Cardiovasc Imaging 2011; 4:169-78. [PMID: 21406663 DOI: 10.1161/circimaging.110.958777] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- William M Suh
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
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41
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Favorable neointimal coverage in everolimus-eluting stent at 9 months after stent implantation: comparison with sirolimus-eluting stent using optical coherence tomography. Int J Cardiovasc Imaging 2011; 28:491-7. [DOI: 10.1007/s10554-011-9849-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Accepted: 03/05/2011] [Indexed: 11/27/2022]
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Mizuno K, Wang Z, Inami S, Takano M, Yasutake M, Asai K, Takano H. Coronary angioscopy: current topics and future direction. Cardiovasc Interv Ther 2011; 26:89-97. [PMID: 24122528 DOI: 10.1007/s12928-011-0055-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Accepted: 01/24/2011] [Indexed: 12/15/2022]
Abstract
Disruption of vulnerable plaque and following thrombus formation are considered the main cause of acute coronary syndrome (ACS). Intracoronary angioscopy is an endoscopic technology that allows direct visualization of the coronary artery lumen and provides detailed information regarding plaque morphology in patients with coronary artery disease. The color and morphology of coronary plaque under angioscopy observation are proposed to be determinants for plaque stability. Angioscopically yellow plaque represents a thin-cap fibroatheroma, and is associated with a higher incidence of disruption and thrombus formation, and may be associated with future acute coronary syndromes. To circumvent the subjectivity of color interpretation, various quantitative methods have been proposed for identifying vulnerable plaques. Superior to other coronary imaging techniques such as VH IVUS and optical coherence tomography, angioscopy has impressively high sensitivity and specificity in detection of intraluminal thrombus. Angioscopy can also be used as an adjunctive technique during catheter intervention by directly visualizing the thrombus, stent struts and proliferating neointima. The time course and pattern of neointima coverage, as seen by angioscopy, various among different stent systems. Angioscopic assessment of serial changes after stent implantation may have potential benefits on patient's management after coronary stenting.
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43
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Wang Z, Inami S, Kirinoki S, Yamamoto H, Takagi G, Aoki S, Kato K, Takano H, Asai K, Yasutake M, Takano M, Yamamoto M, Ohba T, Mizuno K. Angioscopic study of silent plaque disruption in nonischemic related coronary artery in patients with stable ischemic heart disease. Int Heart J 2011; 51:383-7. [PMID: 21173512 DOI: 10.1536/ihj.51.383] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Plaque disruption, which may be associated with some coronary risk factors, plays a key role in the development of acute coronary syndromes and progression of atherosclerosis. However, the clinical profile of asymptomatic plaque disruption in stable ischemic heart disease has not been well evaluated. The aim of the present study was to investigate the frequency and determinants of silent plaque disruption (SPD) in patients with stable ischemic heart disease using coronary angioscopy. Forty-one patients with stable angina or old myocardial infarction (OMI) without any complaints within 3 months were included in the present study. Angioscopy was successfully performed through 49 nonischemic related coronary arteries. The presence of SPD and coronary risk factors were recorded. Silent plaque disruption was found in 12 patients with stable ischemic heart disease (12/41, 29.3%), and the frequency of SPD in nonischemic related coronary arteries was 26.5% (13/49). A significantly higher frequency of SPD was noted in yellow plaques than in white plaques (35.3% versus 6.7%, P = 0.043). Overall, the independent clinical risk factors of SPD in nonischemic related coronary arteries were diabetes mellitus (P = 0.018; OR, 18.8209; 95% CI, 1.6525 to 214.3523) and hypertension (P = 0.0313; OR, 6.6485; 95% CI, 1.1850 to 37.3019). These results suggest silent plaque disruption was commonly observed in nonischemic related coronary arteries in patients with stable ischemic heart disease and its determinants were diabetes mellitus and hypertension.
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Affiliation(s)
- Zuoyan Wang
- First Department of Internal Medicine, Nippon Medical School, Tokyo, Japan
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Herrero-Garibi J, Cruz-González I, Parejo-Díaz P, Jang IK. Optical coherence tomography: its value in intravascular diagnosis today. Rev Esp Cardiol 2011; 63:951-62. [PMID: 20738940 DOI: 10.1016/s1885-5857(10)70189-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Optical coherence tomography is a recently developed high-resolution intravascular diagnostic technique. Initially, it was mainly used for characterizing atherosclerotic plaque because it served a number of functions, from identifying plaque with high lipid content to detecting macrophage accumulation, both of which are associated with plaque instability. Currently, there is growing interest in the value of optical coherence tomography in the area of coronary intervention, where the technique offers significant advantages over more widespread intravascular diagnostic techniques such as intravascular ultrasound: its higher resolution means that the vessel lumen diameter can be measured more precisely, periprocedural complications such microdissection of the coronary artery can be detected, stent apposition relative to the vessel wall can be optimized, neointimal hyperplasia can be detected after stent implantation, and neointimal thickness can be measured. It would therefore appear to be a very useful technique for interventional cardiologists. This review article considers the technical details of the technique and its applications, and compares it with other intravascular diagnostic techniques.
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45
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Hirayama A, Saito S, Ueda Y, Takayama T, Honye J, Komatsu S, Yamaguchi O, Li Y, Yajima J, Nanto S, Takazawa K, Kodama K. Plaque-Stabilizing Effect of Atorvastatin Is Stronger for Plaques Evaluated as More Unstable by Angioscopy and Intravenous Ultrasound. Circ J 2011; 75:1448-54. [DOI: 10.1253/circj.cj-10-1035] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Atsushi Hirayama
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Satoshi Saito
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | | | - Tadateru Takayama
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Junko Honye
- Department of Cardiology, Fuchu Keijin-kai Hospital
| | - Sei Komatsu
- Cardiovascular Division, Amagasaki Central Hospital
| | - Osamu Yamaguchi
- Department of Cardiovascular Medicine, Osaka University, Graduate School of Medicine
| | - Yuxin Li
- Department of Advanced Cardiovascular Imaging, Nihon University School of Medicine
| | - Junji Yajima
- Department of Cardiology, The Cardiovascular Institute Hospital
| | - Shinsuke Nanto
- Department of Advanced Cardiovascular Therapeutics, Osaka University, Graduate School of Medicine
| | - Kenji Takazawa
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center
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46
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Kato K, Yasutake M, Yonetsu T, Joong Kim S, Xing L, M Kratlian C, Takano M, Mizuno K, Jang IK. Intracoronary Imaging Modalities for Vulnerable Plaques. J NIPPON MED SCH 2011; 78:340-51. [DOI: 10.1272/jnms.78.340] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Koji Kato
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School
| | - Masahiro Yasutake
- Department of Internal Medicine, (Division of Cardiology, Hepatology, Geriatrics and Integrated Medicine), Nippon Medical School
| | - Taishi Yonetsu
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School
| | - Soo Joong Kim
- Department of Cardiology, College of Medicine, Kyung Hee University, Seoul, Korea and Cardiology Division, Massachusetts General Hospital and Harvard Medical School
| | - Lei Xing
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School
| | | | - Masamichi Takano
- Cardiovascular Center, Nippon Medical School Chiba Hokusoh Hospital
| | - Kyoichi Mizuno
- Department of Internal Medicine, (Division of Cardiology, Hepatology, Geriatrics and Integrated Medicine), Nippon Medical School
| | - Ik-Kyung Jang
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School
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47
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Uchida Y, Uchida Y, Hiruta N. Histological Characteristics of Glistening Yellow Coronary Plaques Seen on Angioscopy - With Special Reference to Vulnerable Plaques -. Circ J 2011; 75:1913-9. [DOI: 10.1253/circj.cj-10-1286] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Yasuto Uchida
- Department of Cardiology, Toho University Medical Center Ohmori Hospital
| | - Nobuyuki Hiruta
- Department of Pathology, Toho University Medical Center Sakura Hospital
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48
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49
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Kobayashi N, Takano M, Hata N, Yamamoto M, Shinada T, Takahashi Y, Tomita K, Kitamura M, Mizuno K. Optical coherence tomography findings in a case of acute coronary syndrome caused by coronary vasospasm. Int Heart J 2010; 51:291-2. [PMID: 20716848 DOI: 10.1536/ihj.51.291] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Culprit lesions of acute coronary syndrome (ACS) were observed by intravascular optical coherence tomography (OCT). OCT images revealed diffuse intimal thickening, reduced lumen area with vascular contraction, and thrombus formation. No OCT images of atherosclerotic plaque disruption were found. Vascular contraction disappeared and the lumen was dilated after intracoronary injection of nitroglycerin. The main mechanism of ACS in this case was therefore considered to be coronary vasospasm. OCT may be useful for evaluating the mechanism of ACS.
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Affiliation(s)
- Nobuaki Kobayashi
- Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School, Inba, Chiba, Japan
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The year in intracoronary imaging. JACC Cardiovasc Imaging 2010; 3:881-91. [PMID: 20705271 DOI: 10.1016/j.jcmg.2010.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Revised: 04/26/2010] [Accepted: 05/13/2010] [Indexed: 11/20/2022]
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