Coronary artery disease
Assessment of Culprit and Remote Coronary Narrowings Using Optical Coherence Tomography With Long-Term Outcomes

https://doi.org/10.1016/j.amjcard.2008.03.071Get rights and content

Much currently known information about vulnerable plaque stems from postmortem studies that identified several characteristics making them prone to rupture, including the presence of a thin fibrous cap and a large lipid core. This study used optical coherence tomography (OCT) to assess culprit and remote coronary narrowings and investigate whether intracoronary OCT in living patients was able to visualize morphologic features associated with vulnerable plaque in postmortem studies. Twenty-three patients successfully underwent OCT before percutaneous coronary intervention. The culprit lesion and mild to moderate coronary narrowings remote from the target stenosis were investigated. Using OCT, the culprit lesion was found to be fibrous in 39.1%, fibrocalcific in 34.4%, and lipid rich in 26.1% of cases. Two patients met criteria for thin-cap fibroatheroma (TCFA; defined as the presence of a signal-rich fibrous cap covering a signal-poor lipid/necrotic core with cap thickness <0.2 mm). Most plaques at remote segments were proximal to the culprit lesion (73.9%) and predominantly fibrous and lipid rich. OCT identified 7 TCFA lesions in 6 patients with a mean cap thickness of 0.19 ± 0.05 mm, extending for 103° ± 49° of the total vessel circumference. At 24 months of clinical follow-up, the only event occurred in a patient with in-stent restenosis who underwent repeated percutaneous revascularization. There were no clinically apparent plaque rupture–related events in the 6 patients found to have remote TCFA. This study showed that OCT can be safely applied to image beyond the culprit lesion and can detect in vivo morphologic features associated with plaque vulnerability using retrospective pathologic examination. In conclusion, detection of TCFA, particularly in stable patients, is desirable and may principally allow for early intervention and prevention of adverse events.

Section snippets

Methods

From February to August 2004, this single-center observational pilot study examined patients with coronary artery disease. Twenty-three patients scheduled for coronary stent implantation underwent OCT before angioplasty. The culprit lesion and mild to moderate coronary lesions remote from the target stenosis were investigated. Patients were selected based on the presence of stable or unstable angina pectoris with objective evidence of ischemia. Clinical exclusion criteria were poor renal

Results

Baseline clinical and lesion characteristics are listed in Table 1. There was 1 case of transient atrioventricular block during OCT pullback in a 72-year-old man with single-vessel disease. The rest of his clinical course was uneventful, and he was discharged as planned the next day.

OCT analysis of the coronary artery wall was possible in all patients. Mean OCT pullback length was 28.8 ± 12.2 mm. Quantitative measurements at the culprit site showed a mean minimal lumen area and mean minimal

Discussion

The main findings of this study were that (1) OCT could be safely used in vivo to show the heterogeneity of coronary plaques at culprit and remote sites, (2) intravascular OCT could detect in vivo morphologic features associated with plaque vulnerability using retrospective pathologic examination, and (3) the lack of long-term clinical events in our patients with TCFA gave unique antemortem insight into such lesions, although the sample size was small.

The recent introduction of OCT has proved

References (33)

  • H.M. Garcia-Garcia et al.

    Diagnosis and treatment of coronary vulnerable plaques

    Expert Rev Cardiovasc Ther

    (2008)
  • S. Chia et al.

    In-vivo comparison of coronary plaque characteristics using optical coherence tomography in women vs. men with acute coronary syndrome

    Coron Artery Dis

    (2007)
  • G.J. Tearney et al.

    Optical coherence tomography for imaging the vulnerable plaque

    J Biomed Opt

    (2006)
  • I.K. Jang et al.

    In vivo characterization of coronary atherosclerotic plaque by use of optical coherence tomography

    Circulation

    (2005)
  • G.J. Tearney et al.

    Quantification of macrophage content in atherosclerotic plaques by optical coherence tomography

    Circulation

    (2003)
  • K. Tsuchida et al.

    In-vivo validation of a novel three-dimensional quantitative coronary angiography system (CardioOp-B TM): comparison with a conventional two-dimensional system (CASS II TM) and with special reference to optical cohence tomography

    EuroIntervention

    (2007)
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