American College of Cardiology Clinical Expert Consensus Document on Standards for Acquisition, Measurement and Reporting of Intravascular Ultrasound Studies (IVUS). A Report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents Developed in Collaboration with the European Society of Cardiology Endorsed by the Society of Cardiac Angiography and Interventions

Mintz, Gary S.; Nissen, S.E.; Anderson, Wesley D.; Bailey, Steven R.; Erbel, R.; Fitzgerald, P.J.; Pinto, Fausto J.; Rosenfield, Kenneth; Siegel, Robert J.; Tuzcu, E M; Yock, Paul G.

doi:10.1053/euje.2001.0133

Cited by 649 publications

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“…3 A presumptive diagnosis for thrombus was made if there was an intracoronary mass present. 4 Virtual histology (VH) IVUS was performed in the last 5 patients of the series. VH-IVUS uses advanced spectral analysis of radiofrequency ultrasound backscatter to characterize plaque as fibrous (dark green), fibro-fatty (light green), necrotic core (red), and dense calcium (white).…”

Section: Methodsmentioning

confidence: 99%

Takotsubo Cardiomyopathy Is Not Due to Plaque Rupture: An Intravascular Ultrasound Study

Haghi

Roehm

Hamm

et al. 2010

Clinical Cardiology

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BackgroundPlaque rupture with subsequent transient thrombotic coronary occlusion by a fast‐dissolving clot is one of the proposed pathogenic mechanisms in Takotsubo cardiomyopathy (TC).HypothesisThe aim of this study was to seek evidence for the hypothesis of transient coronary thrombosis as the underlying mechanism of TC by means of intravascular ultrasound (IVUS).MethodsIn our database of 63 consecutive patients with TC we identified 10 patients (16%) who had undergone IVUS during their initial left heart catheterisation.ResultsA median length of 67 mm of the left anterior descending artery was analyzed (interquartile range [IQR]: 63.3–70.1 mm). Median lumen diameter, median vessel diameter, median plaque and media volume were 2.9 mm (IQR: 2.7–3.1 mm), 4.2 mm (IQR: 3.8–4.4 mm), and 90.9 mm3 (IQR: 70.4–101.4 mm3), respectively. Plaque rupture, positive remodeling, and presumed intracoronary thrombus were absent in all patients.ConclusionIn conclusion, plaque rupture does not account for the regional wall motion abnormalities observed in TC. The previously reported observation of plaque rupture in TC seems to constitute an incidental finding. We suggest that the theory of aborted myocardial infarction as the underlying cause of TC should be abandoned once and for all. Copyright © 2010 Wiley Periodicals, Inc.

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Section: Methodsmentioning

confidence: 99%

Takotsubo Cardiomyopathy Is Not Due to Plaque Rupture: An Intravascular Ultrasound Study

Haghi

Roehm

Hamm

et al. 2010

Clinical Cardiology

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“…IVUS is currently the only commercially available clinical technique providing real-time cross-sectional images of the coronary artery [7]. Using IVUS, the morphologies of the coronary wall and plaque are obtained.…”

Section: Intravascular Palpography Is a Technique Based On Intravascumentioning

confidence: 99%

Intravascular Palpography for High-Risk Vulnerable Plaque Assessment

Schaar

Korte

Mastik³

et al. 2003

Herz

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Background:The composition of an atherosclerotic plaque is considered more important than the degree of stenosis. An unstable lesion may rupture and cause an acute thrombotic reaction. Most of these lesions contain a large lipid pool covered by an inflamed thin fibrous cap. The stress in the cap increases with decreasing cap thickness and increasing macrophage infiltration. Intravascular ultrasound (IVUS) palpography might be an ideal technique to assess the mechanical properties of high-risk plaques. Technique: Palpography assesses the local mechanical properties of tissue using its deformation caused by the intraluminal pressure. In Vitro Validation:The technique was validated in vitro using diseased human coronary and femoral arteries. Especially between fibrous and fatty tissue, a highly significant difference in strain (p = 0.0012) was found. Additionally, the predictive value to identify the vulnerable plaque was investigated. A high-strain region at the lumen-vessel wall boundary has an Intravaskuläre Palpographie zur Erfassung vulnerabler Hochrisikoplaques

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“…Despite its lower sensitivity in the detection of plaque surface erosions or small thrombi 13,14 compared to angioscopy, IVUS remains the most common supplementary tool used for coronary imaging and provides adequate resolution for diagnosis of clinically significant intraluminal, plaque and stent associated thrombi. 11 Several features characteristic of thrombi have been described on IVUS examination 11,15,16 and validated both in-vitro 17,18 and in-vivo. 19 The criteria most commonly used for the diagnosis of thrombus on IVUS include the presence of an echodense structure within the lumen or adjacent to the arterial wall or a stent without any evidence of blood flow inside.…”

Section: Discussionmentioning

confidence: 91%

“…19 The criteria most commonly used for the diagnosis of thrombus on IVUS include the presence of an echodense structure within the lumen or adjacent to the arterial wall or a stent without any evidence of blood flow inside. 4,8,11,17 As highlighted by the reported cases, the accurate characterization of the angiographic filling defects with IVUS examination not only renders an accurate diagnosis but also allows for a targeted therapy specific to the underlying pathology. A calcified atherosclerotic plaque seen on IVUS requires aggressive lesion dilatation with a noncompliant balloon or plaque modification with a cutting balloon or rotational atherectomy, techniques that would be contraindicated in the presence of a thrombus or a dissection.…”

Section: Discussionmentioning

confidence: 98%

“…IVUS on the other hand provides superior image resolution (axial resolution of 100 to 200µm and a lateral resolution of 250 µm with 20 to 40 MHz catheter 10 ) with tissue characteristics of the luminal contents and morphology of the arterial wall. Although, IVUS affords excellent sensitivity for the detection of mural calcification 2,11,12 and coronary dissection, 8,13 no pathognomonic features of thrombi on IVUS examination have been described and coronary angioscopy remains the gold standard for its diagnosis. 3,4,13 However, the use of angioscopy is limited to research applications in most catheterization laboratories due to the associated technical challenges.…”

Section: Discussionmentioning

confidence: 99%

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Intraluminal Filling Defects on Coronary Angiography: More than Meets the Eye

Jaffe

Irfan

Hong

et al. 2007

Clinical Cardiology

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SummaryIntraluminal filling defects are occasionally encountered on coronary angiography and often related with coronary thrombi. However, other conditions affecting the coronary arteries may present with similar angiographic findings causing diagnostic uncertainty. Accurate characterization of the angiographic filling defect is critical, particularly in patients planned for a percutaneous coronary intervention (PCI), as diagnosis of a coronary thrombus not only increases the risk of post procedural adverse events but also requires a specific therapeutic approach. In this paper, we report three patients in whom coronary angiography revealed intraluminal filling defects mimicking coronary thrombi. When further investigated with intravascular ultrasound (IVUS) as a part of the planned PCI, the thrombus was excluded and alternate etiology of the filling defect was confirmed in all patients. The angiographic "pseudothrombi" were produced by coronary dissection in one and by heavy calcification within the atherosclerotic plaque in two patients. The use of IVUS allowed accurate characterization of the angiographic filling defect and provided important information to guide management and optimize therapeutic approach. Coronary angiography is a common investigation performed in patients suspected with coronary artery disease. 1 Intraluminal filling defects are occasional findings on coronary angiography and may present a diagnostic and a therapeutic dilemma. Although they are often associated with intra coronary thrombi, particularly in the setting of an acute coronary syndrome, several other pathologies such as coronary artery dissection, emboli, mural calcification and unopposed stent struts in a previously stented segment may also result in similar angiographic findings. As the treatment markedly differs for these diverse conditions, it is imperative to characterize the true nature of these filling defects for proper diagnosis and management. In this paper, we report three cases with intraluminal filling defects that mimicked thrombi on coronary angiography. However, further interrogation with IVUS revealed alternate causes for the angiographic appearance. The accurate identification of the underlying pathology allowed application of a specific treatment strategy with good clinical outcome. Case 1An 85-year-old man with past medical history of hypertension, dyslipidemia and peripheral vascular disease was hospitalized after an inferior ST-elevation myocardial infarction. He did not receive thrombolytic therapy due to late presentation, but experienced further angina after admission to the coronary care unit. Coronary angiography revealed moderate disease in the left coronary artery and two intraluminal filling defects in the mid-segment of the right coronary artery (RCA), Fig. 1(A), suggesting presence of thrombi. An IVUS

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Cited by 649 publications

References 0 publications

Takotsubo Cardiomyopathy Is Not Due to Plaque Rupture: An Intravascular Ultrasound Study

Takotsubo Cardiomyopathy Is Not Due to Plaque Rupture: An Intravascular Ultrasound Study

Intravascular Palpography for High-Risk Vulnerable Plaque Assessment

Intraluminal Filling Defects on Coronary Angiography: More than Meets the Eye

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