Angioscopic Evaluation of Spontaneously Ruptured Aortic Plaques

Abstract

SRAP are commonly scattered, and their dimensions were smaller than previously recognized. (Detecting Ruptured Aortic Plaques by Nonobstructive Angioscopy; UMIN000029772).

Visible-free cholesterol crystal emboli adjacent to microinfarcts in myocardial capillaries and arterioles on H&E-stained frozen sections of an autopsied patient

“…Unfortunately, the existence and significance of fCCE have been overlooked for a long time 11 12. As described recently,4 we proposed that AE were classified two main groups: AE including CCs, fibrin, red blood cells, macrophages and calcification; and fCCE including only CCs. The former will rapidly cause much more larger infarcts that are visible on imaging, such as CT, MRI and optical coherence tomography, rather than the latter; the latter will very slowly cause small or tiny infarcts that will not be recognised only on imaging studies, during the clinical course, or on histological examination.…”

“…Although atheromatous emboli (AE), including cholesterol crystals (CCs), fibrin, macrophages and calcification, are released into coronary circulation during percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS),1–3 AE are divided into two main groups: classic AE and free cholesterol crystal emboli (fCCE) 4. The number of released fCCE and their role in ACS have not been documented yet.…”

Association between eosinophilia and renal prognosis in patients with pathologically proven cholesterol crystal embolism

“…Recently ruptured aortic plaques, which might cause atheromatous embolization, are thought to be not mainly iatrogenic, but spontaneous and continuously ongoing. Komatsu et al showed that spontaneous ruptured aortic plaques (SRAP) are present in about 86.4% of patients who were suspected to have stable angina with no aneurysms, using nonobstructive angioscopy (NOA) [22]. Therefore, in patients with aneurysms with increased number of thrombi, NOA might help to identify a greater number of SRAP.…”

Low Endothelial Sheer Stress ― A Silent Killer ―

“…11 Recently, Komatsu et al observed the aortic wall on angioscopy in 324 patients with suspected coronary artery disease (CAD). 12 They found spontaneous ruptured aortic plaque in 262 patients (80.9%), of whom 120 patients had plaque rupture below the diaphragm portion of the aorta (Figure 1). 12 Figure 2 shows representative angioscopy of the descending aorta of our case.…”

“…12 They found spontaneous ruptured aortic plaque in 262 patients (80.9%), of whom 120 patients had plaque rupture below the diaphragm portion of the aorta (Figure 1). 12 Figure 2 shows representative angioscopy of the descending aorta of our case. Ruptured plaque, subintimal bleeding and cholesterol crystal were observed in the infrarenal aorta but the vulnerability was lower in the suprarenal aorta.…”