Roles of Intravascular Ultrasound in Patients with Acute Myocardial Infarction

Abstract

Rupture of a vulnerable plaque and subsequent thrombus formation are important mechanisms leading to the development of an acute myocardial infarction (AMI). Typical intravascular ultrasound (IVUS) features of AMI include plaque rupture, thrombus, positive remodeling, attenuated plaque, spotty calcification, and thin-cap fibroatheroma. No-reflow phenomenon was attributable to the embolization of thrombus and plaque debris that results from mechanical fragmentation of the vulnerable plaque by percutaneous coronary intervention (PCI). Several grayscale IVUS features including plaque rupture, thrombus, positive remodeling, greater plaque burden, decreased post-PCI plaque volume, and tissue prolapse, and virtual histology-IVUS features such as large necrotic corecontaining lesion and thin-cap fibroatheroma were the independent predictors of no-reflow phenomenon in AMI patients. Non-culprit lesions associated with recurrent events were more likely than those not associated with recurrent events to be characterized by a plaque burden of ≥70%, a minimal luminal area of ≤4.0 mm2, or to be classified as thin-cap fibroatheromas.

Intravascular modality‐guided versus angiography‐guided percutaneous coronary intervention in acute myocardial infarction

“…Despite a wealth of data demonstrating clinical benefit of IVUS, OCT, and FFR in the evaluation of complex lesion, IVUS (19.9%), OCT (2.4%), and FFR (1.3%) were used in only a small minority of AMI patients. The use of intracoronary imaging such as IVUS and OCT was likely more common than FFR because determining optimal stent sizing and landing zone is challenging in the presence of thrombus and vessel spasm during PCI for AMI patients . In the previous National Cardiovascular Data Registry, IVUS and FFR were utilized in 20.3 and 6.1% of patients, respectively .…”

“…The use of intracoronary imaging such as IVUS and OCT was likely more common than FFR because determining optimal stent sizing and landing zone is challenging in the presence of thrombus and vessel spasm during PCI for AMI patients. 12,13 In the previous National Cardiovascular Data…”

Multimodality Intravascular Imaging Assessment of Plaque Erosion versus Plaque Rupture in Patients with Acute Coronary Syndrome

“…However, the mechanisms of plaque erosion remain unclear and the clinical importance and impact have been underestimated due to limited resolution of intravascular ultrasound (IVUS) and computed tomography. 4) In addition, small plaque ruptures and unruptured thin-capped fibroatheromas (TCFA) with superimposed thrombosis have not been fully evaluated. 5) 6) …”

Assessment of vasa vasorum on coronary plaques in patients with acute coronary syndromes using intravascular ultrasound and iMap analysis: A retrospective cohort study

“…The etiopathogenesis of NRP is multifactorial, with 1 factor being the mechanical fragmentation of the vulnerable plaque during PCI, causing distal embolization of thrombi, substantial lipidic content, and plaque debris disturbing the coronary microcirculation with an element of elevated local thrombogenicity. [30] The necrotic core constituent of the virtual histology comprises vulnerable tissue, such as cholesterol crystals, lipidic deposition with foam cells, microcalcification, and intramural hemorrhage that undergo mechanical fragmentation during PCI and embolize to the distal coronary microcirculation, facilitating NRP. [10,31,32] TCFA, characterized by fibrosis tissue thickness of <65 μm with a potential necrosis core, is the precursor lesion for plaque rupture.…”