Impact of coronary artery remodeling on clinical presentation of coronary artery disease: an intravascular ultrasound study

Nakamura, Mamoo; Nishikawa, Hideo; Mukai, Sei; Setsuda, Morimichi; Nakajima, Kei; Tamada, Hiroya; Suzuki, Hiroyuki; Ohnishi, Takahiro; Kakuta, Yutaka; Nakano, Takeshi; Yeung, Alan C.

doi:10.1016/s0735-1097(00)01097-4

Cited by 269 publications

(142 citation statements)

References 37 publications

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“…Plaque remodeling ratio (RR) was determined by 1) measurement of the outside vessel circumference of the extracranial internal carotid artery at the point of maximal luminal stenosis, and 2) was divided by the outside vessel circumference at a region unaffected by atherosclerotic disease (Figs 1 and 2). The rationale for this method is based on earlier work by Nakamura et al, 13 who evaluated plaque remodeling in the coronary circulation. All circumference measurements were performed by a single blinded investigator.…”

Section: Image Interpretationmentioning

confidence: 99%

The Impact of Expansive Arterial Remodeling on Clinical Presentation in Carotid Artery Disease: A Multidetector CT Angiography Study

Hardie¹,

Kramer²,

Raghavan³

et al. 2007

American Journal of Neuroradiology

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Section: Image Interpretationmentioning

confidence: 99%

The Impact of Expansive Arterial Remodeling on Clinical Presentation in Carotid Artery Disease: A Multidetector CT Angiography Study

Hardie¹,

Kramer²,

Raghavan³

et al. 2007

American Journal of Neuroradiology

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“…In addition, a previous paper has shown no significant difference in the remodeling index between unstable and stable angina Japanese patients. 30) They also reported a larger remodeling index in acute MI patients compared with UAP patients. UAP patients but not acute MI patients may more frequently have coronary endothelial erosion with mural thrombus and negative remodeling compared with acute MI patients.…”

Section: Discussionmentioning

confidence: 94%

“…Written informed consent was obtained from all patients. We investigated 30 consecutive patients with UAP (n = 14) and SAP (n = 16) who underwent 64-slice CTCA and then percutaneous coronary intervention (PCI) in our hospital between April 1, 2006 and December 30,2006. UAP patients underwent PCI within 1 week after 64-slice CTCA; SAP patients underwent PCI within 1 month after 64-slice CTCA.…”

Section: Methodsmentioning

confidence: 99%

Coronary Artery CT Low-Density Plaque Area and Its Ratio to the Whole Area of a Non-Calcified Plaque at the Culprit Lesion in Patients With Unstable and Stable Coronary Artery Disease

et al. 2012

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SummaryIntravascular ultrasound studies have shown that patients with unstable angina pectoris (UAP) more frequently had soft plaques in the culprit coronary arteries than patients with stable angina pectoris (SAP). We evaluated coronary plaque characteristics of culprit lesions in patients with UAP by 64-slice computed tomographic coronary angiography (64-slice CTCA). 64-slice CTCA (Aquilion 64, Toshiba Medical Systems, Otawara, Japan) was performed in 30 patients (UAP = 14, SAP = 16) before percutaneous coronary intervention (PCI). Coronary plaque area was measured by manual tracing for the difference between the area within the external elastic membrane and the area of the vessel lumen at the site of maximal luminal narrowing as observed on a cross-sectional 64-slice CTCA image where PCI was performed. Within this plaque area, CT low-density plaque area (< 50 Hounsfield units) was automatically calculated. There were no differences in stenotic rate and whole plaque area of the culprit lesion between patients with UAP and SAP. However, the CT low-density plaque area was significantly greater in patients with UAP than in those with SAP. A greater area of CT low-density plaque in the culprit lesion is associated with UAP rather than SAP. Measuring CT-low density plaque area on 64-slice CTCA images could be useful for understanding the clinical setting of UAP. (Int Heart J 2012; 53: 341-346) Key words: Unstable angina pectoris, Coronary artery plaque, Computed tomography, Lipid-rich coronary plaque R ecently, 64-slice computed tomographic coronary angiography (64-slice CTCA) has been shown to detect significant coronary stenosis (> 50% luminal narrowing) with high sensitivity and specificity as compared with invasive coronary angiography.1-7) The per segment sensitivity and specificity ranged from 80% to 99% and 85% to 95%, respectively. 4,5) Moreover, 64-slice CTCA can accurately assess plaque area and remodeling index with good correlation to intravascular ultrasound (IVUS) with good image quality in selected patients. 3,8,9) Very recently, it has been shown that 64-CT is an effective way to distinguish different qualities of coronary atherosclerotic plaque and suggest that serum Hs-CRP and IL-6 levels can be considered as one of the indexes to judge the degree of CHD and may reflect the activities of plaque in CHD patients. Thus it is important for clinical diagnosis and risk evaluation of ACS patients. 10)In addition to the evaluation of coronary artery plaque area, 64-slice CTCA enabled the evaluation of the plaque composition of the culprit lesion in patients with acute coronary syndromes (ACS) and stable angina pectoris (SAP).11-13) Culprit atherosclerotic lesions in ACS patients showed complex findings such as spotty calcification, lipid-rich plaques, and positive vascular remodeling, whereas the culprit lesions in SAP patients showed these features less frequently. 14,15) Discrete lesions detected by multislice CT were found more in patients with unstable angina pectoris or a STEMI, while diffuse and ...

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“…According to the IVUS findings, the degree of PR is greater in AMI than in UA. 11) When comparing ST elevation myocardial infarction …”

Section: Gs-ivus: Gray Scale-ivus Vh-ivus: Virtual Histologymentioning

confidence: 99%

Acute Coronary Syndrome: Insights Based on Intravascular Imaging

2012

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Intravascular imaging devices can offer information about vessels that cannot be depicted by angiography. Intravascular ultrasound (IVUS) can image the trilaminar structure of vessel walls and not only enable quantitative analysis, but also tissue characterization by radiofrequency data analysis. Coronary angioscopy provides full color images as direct visualization of the coronary lumen, and the images are applicable to the macroscopic diagnosis of intracoronary structures. Optical coherence tomography (OCT) is a novel optical imaging technology that provides cross-sectional tomographic images that yield detailed structural information superior to any other currently available modality. These intravascular imaging devices have played an important role both in the elucidation of the pathology of coronary artery disease and in the guidance of clinical treatment. Rupture of atherosclerotic plaque and the overlying thrombus is often observed in culprit lesions of acute coronary syndrome (ACS). In vivo, intravascular imaging devices can show detailed morphology of the culprit lesion that is associated with the clinical presentation and the prognosis. Ruptureprone plaques are called vulnerable plaques. Identification of vulnerable plaques has been attempted over the years. Prospective studies have shown that thin cap fibroatheroma (TCFA), defined by different intravascular imaging devices, is related to future cardiac events. Furthermore, multiple vulnerable plaques are often observed in non-culprit arteries of ACS patients. Therefore, ACS is recognized to represent a pancoronary process of vulnerable plaque development. In addition, the multiplicity of vulnerable plaques was also demonstrated to be a predictor of ACS events. Some cardiac biomarkers, which are reported to be predictors of ACS events, are associated with the characterization of culprit and non-culprit arteries in ACS patients. On the other hand, the detailed findings obtained by intravascular imaging devices play an important role to prove the validity of noninvasive coronary artery studies. Near-infrared spectroscopy and coronary thermography can reveal plaque vulnerability by detecting inflammation and by quantifying the molecular composition of the plaque. The introduction of new technologies will increase our understanding of the pathophysiology and prevention of ACS.

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Impact of coronary artery remodeling on clinical presentation of coronary artery disease: an intravascular ultrasound study

Abstract: Positive remodeling was more frequently observed in ACS than in stable CAD. Moreover, the degree of positive remodeling was greater in AMI than in UAP. These results may reflect the impact of remodeling types and its degree in the culprit lesion of CAD on clinical presentation.

Cited by 269 publications

References 37 publications

The Impact of Expansive Arterial Remodeling on Clinical Presentation in Carotid Artery Disease: A Multidetector CT Angiography Study

The Impact of Expansive Arterial Remodeling on Clinical Presentation in Carotid Artery Disease: A Multidetector CT Angiography Study

Coronary Artery CT Low-Density Plaque Area and Its Ratio to the Whole Area of a Non-Calcified Plaque at the Culprit Lesion in Patients With Unstable and Stable Coronary Artery Disease

Acute Coronary Syndrome: Insights Based on Intravascular Imaging

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