Incidence and Predictors of Plaque Rupture in the Peripheral Arteries

Abstract

Background-Plaque rupture may be present in the peripheral arteries of the patients at high risk for cardiovascular events and is possibly associated with vascular vulnerability. Methods and Results-One hundred one iliofemoral arteries from 101 patients undergoing angioplasty were studied.Intravascular ultrasound imaging was performed before intervention. Plaque rupture was defined as presence of a cavity that communicated with the lumen with an overlying residual fibrous cap fragment. Incidence, numbers, and location of the plaque rupture were investigated. Plaque rupture was found in 42 of 101 arteries (42%). Patients with plaque rupture had significantly higher prevalence of acute coronary syndrome than did patients without plaque rupture (42% vs 16%, Pϭ0.01). By multivariable logistic regression analysis, acute coronary syndrome (Pϭ0.004) and male sex (Pϭ0.01) were independent clinical correlates of plaque rupture. During follow-up (median, 14.7 months), the incidence of major adverse cardiac or cerebrovascular events (death, myocardial infarction, and ischemic stroke) was similar between the 2 groups. The incidence of major adverse cardiac or cerebrovascular events plus peripheral vascular events (unplanned vascular intervention and amputation) was significantly higher in patients with plaque rupture than in patients without plaque rupture (46% vs 21%, Pϭ0.008). By multivariable Cox regression analysis, plaque rupture (hazard ratioϭ2.80, 95% CI: 1.23 to 6.37, Pϭ0.01) and Fontaine stage IV (hazard ratioϭ3.50, 95% CI: 1.58 to 7.71, Pϭ0.002) were independent predictors of major adverse cardiac or cerebrovascular events plus peripheral vascular events. Conclusions-Ruptured plaque of the iliofemoral arteries is a common finding. Patients with plaque rupture had a higher prevalence of history of acute coronary syndrome and lower major adverse cardiac or cerebrovascular events plus peripheral vascular event-free survival. (Circ Cardiovasc Interv. 2010;3:63-70.)

Atherosclerotic Plaque Inflammation Varies Between Vascular Sites and Correlates With Response to Inhibition of Lipoprotein‐Associated Phospholipase A 2

“…This discordance between plaque severity and inflammatory response in the AAs was unexpected but corroborates previously published human data. Clinical studies have shown that systemic inflammation defined by CRP levels is greater in patients with COR atherosclerosis and evidence of plaque rupture, whereas the largest study to assess peripheral plaque rupture in the iliofemoral arteries showed no such association with CRP levels . By showing that AA lesion area correlates with levels of plasma glucose while COR lesion area does not, it appears that disease severity in the AAs is directly related to hyperglycemia while in the CORs this is not the case.…”

“…Clinical studies have shown that systemic inflammation defined by CRP levels is greater in patients with COR atherosclerosis and evidence of plaque rupture, whereas the largest study to assess peripheral plaque rupture in the iliofemoral arteries showed no such association with CRP levels. 15 – 16 By showing that AA lesion area correlates with levels of plasma glucose while COR lesion area does not, it appears that disease severity in the AAs is directly related to hyperglycemia while in the CORs this is not the case. A potential explanation is that the presence of hyperglycemia indirectly drives atherosclerosis development and progression in the CORs via an effect on inflammation.…”

Invasive evaluation of plaque morphology of symptomatic superficial femoral artery stenoses using combined near-infrared spectroscopy and intravascular ultrasound

“…However, other investigators have reported correlations between PAD atherosclerosis and IVUS in the femoral arteries, 26 and IVUS has been reported in PAD patients for identifying plaque rupture. 20 Other studies have compared IVUS and angiography for assessment of vessel and lumen dimensions and for plaque morphology in PAD patients. 19 Two major reviews discussed the applications of IVUS in PAD patients, specifically for assessment of vessel dimensions and plaque morphology.…”

Rapid High-resolution, Self-registered, Dual Lumen-contrast MRI Method for Vessel-wall Assessment in Peripheral Artery Disease:

“…Although vulnerable plaques were investigated in patients with PAD, coverage was limited to a segment of less than 3 cm of the SFA (40) because the acquisition of multicontrast images is challenging given the large number of images needed to cover the entire vascular territory of the leg; the same holds true for alternative approaches. Nevertheless, recent studies using intravascular ultrasound (US) (41) suggest that the identification of vulnerable plaques or plaque ruptures in PA is potentially important in terms of patient management and prognosis. Okura et al found that there was a significant association between plaque rupture in iliofemoral arteries in patients with severe PAD and high prevalence of history of acute coronary syndrome.…”