Intravascular ultrasound insights into the unstable features of the coronary atherosclerotic plaques: A systematic review and meta‐analysis

Abstract

Background: There is a lack of a comprehensive picture of plaque geometry and composition of unstable atherosclerotic lesions as observed with intravascular ultrasound techniques.We analysed through a systematic review with meta-analysis 39 characteristics of atherosclerotic plaques in three scenarios involving culprit and non-culprit lesions from acute coronary syndromes vs stable angina pectoris patients, and culprit vs nonculprit lesions in acute coronary syndromes patients. Methods: A systematic search of PubMed and EMBASE, from inception to April 2020 was performed. The combined odds ratios or mean differences of all IVUS characteristics were calculated with random-effects models. Results: Twenty-eight studies involving 5434 subjects, and 5618 lesions were included. Culprit lesions in acute coronary syndromes have larger plaque areas and remodeling indexes (MD = 0.13 [0.08; 0.17], p < 0.001) and contained larger necrotic cores (MD = 0.67 (95% CI 0.19;1.15), p = 0.006) that stable angina culprit lesions.In acute patients, culprit plaques were also more remodeled, had larger necrotic cores and had more frequently a Thin-Cap Fibroatheroma morphology (OR = 1.79 (95% CI 1.21; 2.65), p = 0.004) than non-culprit lesions. Non-culprit lesions in acute syndromes were more often ruptured (OR = 2.25 (95% CI:1.05; 4.82), p = 0.037) or Thin-Cap Fibroatheromas than in stable angina. Conclusion: Culprit lesions from acute coronary patients are larger, more positively remodeled and contained more lipids as compared to stable angina lesions or nonculprit in acute patients. Non culprit lesions are also more often complicated or vulnerable in acute than stable patients.

Radial Artery Calcification in Predicting Coronary Calcification and Atherosclerosis Burden

“…They coalesce into larger mases over time to form speckles, further progressing to calcified sheets or plates. Fragmentation of these sheets leads to nodules that may extend to the lumen and become protuberant with discontinuation of the endothelium [ 15 ]. Calcification of coronary arteries is an excellent predictor of atherosclerotic plaque burden and may contribute to atherosclerotic plaque rupture, though the connection between atherosclerotic plaque calcification plaque rupture is heavily debated.…”

“…Several studies show a link between high CAC and risk of cardiac events and mortality, yet some studies have suggested that the most calcified plaques may be more stable, and that the plaques most vulnerable to rupture may be those which have a mixed composition of calcified and uncalcified tissue [ 16 ]. Indeed, unstable lesions are associated with focal calcium deposits that may be related to fibrous cap disruption [ 15 ]. Calcium in a spotty distribution has previously been observed, pathologically, in sudden coronary death victims [ 17 ].…”

Approaches to Peripheral Artery Disease in Diabetes: Are There Any Differences?

“…The phenotypic manifestations of atherosclerosis vary in each individual and throughout the body; it is not fully understood why plaque formation has such a heterogeneous distribution, although different arterial systems are correlated [ 1 , 2 , 3 ]. Moreover, risk factors (such as diabetes mellitus, hypertension, smoking, etc.)…”

Optical Coherence Tomography—OCT for Characterization of Non-Atherosclerotic Coronary Lesions in Acute Coronary Syndromes

“…OCT or Intravascular Ultrasound (IVUS) offers the third dimension to the coronary lumen and wall and, due to CA limitations and low sensitivity, is the only method for accurate SCAD diagnosis [ 8 , 9 , 27 , 28 , 29 , 30 ]. Both methods can provide the SCAD diagnosis, but OCT, due to its superior resolution in image acquisitions, is the method of choice [ 8 , 9 ].…”