1
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Tsujimura T, Mizote I, Ishihara T, Nakamura D, Okamoto N, Shiraki T, Itaya N, Takahara M, Nakayoshi T, Iida O, Hata Y, Nishino M, Ueno T, Nakatani D, Hikoso S, Nanto S, Mano T, Sakata Y. Impact of baseline yellow plaque assessed by coronary angioscopy on vascular response after stent implantation. J Cardiol 2024; 84:201-207. [PMID: 38641319 DOI: 10.1016/j.jjcc.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/28/2024] [Accepted: 04/12/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND The relationship between baseline yellow plaque (YP) and vascular response after stent implantation has not been fully investigated. METHODS This was a sub-analysis of the Collaboration-1 study (multicenter, retrospective, observational study). A total of 88 lesions from 80 patients with chronic coronary syndrome who underwent percutaneous coronary intervention were analyzed. Optical coherence tomography (OCT) and coronary angioscopy (CAS) were serially performed immediately and 11 months after stent implantation. YP was defined as the stented segment with yellow or intensive yellow color assessed by CAS. Neoatherosclerosis was defined as a lipid or calcified neointima assessed by OCT. OCT and CAS findings at 11 months were compared between lesions with baseline YP (YP group) and lesions without baseline YP (Non-YP group). RESULTS Baseline YP was detected in 37 lesions (42 %). OCT findings at 11 months showed that the incidence of neoatherosclerosis was significantly higher in the YP group (11 % versus 0 %, p = 0.028) and mean neointimal thickness tended to be lower (104 ± 43 μm versus 120 ± 48 μm, p = 0.098). CAS findings at 11 months demonstrated that the dominant and minimum neointimal coverage grades were significantly lower (p = 0.049 and P = 0.026) and maximum yellow color grade was significantly higher (p < 0.001) in the YP group. CONCLUSIONS Baseline YP affected the incidence of neoatherosclerosis as well as poor neointimal coverage at 11 months after stent implantation.
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Affiliation(s)
| | - Isamu Mizote
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
| | | | - Daisuke Nakamura
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | | | - Tatsuya Shiraki
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Naoki Itaya
- Division of Cardiovascular Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Mitsuyoshi Takahara
- Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takaharu Nakayoshi
- Division of Cardiovascular Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Osamu Iida
- Cardiovascular Division, Osaka Police Hospital, Osaka, Japan
| | - Yosuke Hata
- Kansai Rosai Hospital, Cardiovascular Center, Amagasaki, Japan
| | - Masami Nishino
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | - Takafumi Ueno
- Division of Cardiology, Marine Hospital, Fukuoka, Japan
| | - Daisaku Nakatani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Shungo Hikoso
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Shinsuke Nanto
- Department of Cardiovascular Medicine, Nishinomiya Municipal Central Hospital, Nishinomiya, Japan
| | - Toshiaki Mano
- Kansai Rosai Hospital, Cardiovascular Center, Amagasaki, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
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2
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Faisal S, Barbour M, Seibel EJ, Aliseda A. Hemodynamics of Saline Flushing in Endoscopic Imaging of Partially Occluded Coronary Arteries. Cardiovasc Eng Technol 2024; 15:211-223. [PMID: 38191806 DOI: 10.1007/s13239-023-00708-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 12/19/2023] [Indexed: 01/10/2024]
Abstract
PURPOSE Intravascular endoscopy can aid in the diagnosis of coronary atherosclerosis by providing direct color images of coronary plaques. The procedure requires a blood-free optical path between the catheter and plaque, and achieving clearance safely remains an engineering challenge. In this study, we investigate the hemodynamics of saline flushing in partially occluded coronary arteries to advance the development of intravascular forward-imaging catheters that do not require balloon occlusion. METHODS In-vitro experiments and CFD simulations are used to quantify the influence of plaque size, catheter stand-off distance, saline injection flowrate, and injection orientation on the time required to achieve blood clearance. RESULTS Experiments and simulation of saline injection from a dual-lumen catheter demonstrated that flushing times increase both as injection flow rate (Reynolds number) decreases and as the catheter moves distally away from the plaque. CFD simulations demonstrated that successful flushing was achieved regardless of lumen axial orientation in a 95% occluded artery. Flushing time was also found to increase as plaque size decreases for a set injection flowrate, and a lower limit for injection flowrate was found to exist for each plaques size, below which clearance was not achieved. For the three occlusion sizes investigated (90, 95, 97% by area), successful occlusion was achieved in less than 1.2 s. Investigation of the pressure fields developed during injection, highlight that rapid clearance can be achieved while keeping the arterial overpressure to < 1 mmHg. CONCLUSIONS A dual lumen saline injection catheter was shown to produce clearance safely and effectively in models of partially occluded coronary arteries. Clearance was achieved across a range of engineering and clinical parameters without the use of a balloon occlusion, providing development guideposts for a fluid injection system in forward-imaging coronary endoscopes.
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Affiliation(s)
- Syed Faisal
- Mechanical Engineering Department, University of Washington, Seattle, WA, USA
| | - Michael Barbour
- Mechanical Engineering Department, University of Washington, Seattle, WA, USA.
| | - Eric J Seibel
- Mechanical Engineering Department, University of Washington, Seattle, WA, USA
| | - Alberto Aliseda
- Mechanical Engineering Department, University of Washington, Seattle, WA, USA
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3
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Nakahara T, Strauss HW, Narula J, Jinzaki M. Vulnerable Plaque Imaging. Semin Nucl Med 2023; 53:230-240. [PMID: 36333157 DOI: 10.1053/j.semnuclmed.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/27/2022] [Accepted: 08/30/2022] [Indexed: 11/13/2022]
Abstract
Atherosclerotic plaques progress as a result of inflammation. Both invasive and noninvasive imaging techniques have been developed to identify and characterize plaque as vulnerable (more likely to rupture and cause a clinical event). Imaging techniques to identify vulnerable include identifying vessels with focal subendothelial collections of I) inflammatory cells; II) lipid/ fatty acid; III) local regions of hypoxia; IV) local expression of angiogenesis factors; V) local expression of protease; VI) intravascular foci of thrombus; hemorrhage (most often seen in the aftermath of a clinical event); VII) apoptosis and VIII) microcalcification. This review provides an overview of atherosclerotic plaque progression and tracers which can visualize specific molecules associated with vulnerability.
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Affiliation(s)
- Takehiro Nakahara
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan.
| | - H William Strauss
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jagat Narula
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Mahahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
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4
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Identification of post-procedural optical coherence tomography findings associated with the 1-year vascular response evaluated by coronary angioscopy. Cardiovasc Interv Ther 2023; 38:86-95. [PMID: 35917060 DOI: 10.1007/s12928-022-00880-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 07/18/2022] [Indexed: 01/06/2023]
Abstract
Optical coherence tomography (OCT) provides higher resolution intravascular imaging and allows detailed evaluations of stent implantation sites post-percutaneous coronary intervention (PCI). Coronary angioscopy (CAS) can evaluate the vascular response after drug-eluting stent (DES) implantation. The post-PCI OCT findings that are associated with the CAS 1-year vascular response have not been known. We enrolled 168 lesions from 119 patients who underwent OCT-guided PCI using DES and follow-up CAS observation at 1 ± 0.5 year from August 2012 to December 2019. Outcome measures were sufficient neointimal coverage (NIC) defined as stent struts embedded in the neointima, subclinical intrastent thrombus, and vulnerable stented segments defined as those with angioscopic yellow or intensive yellow color 1 year after PCI. We identified the post-PCI OCT findings associated with these CAS findings. Sufficient NIC, subclinical intrastent thrombus, and vulnerable stented segment were detected in 85 lesions (51%), 47 lesions (28%), and 54 lesions (32%), respectively. A multivariate analysis demonstrated that malapposed struts were negatively associated with sufficient NIC (odds ratio 0.87; 95% CI 0.76-0.99; p = 0.029). However, no specific OCT findings immediately after PCI were associated with subclinical intrastent thrombus or vulnerable stented segment. Malapposition immediately after PCI was negatively associated with sufficient NIC at 1 year even without associations between post-PCI OCT findings and subclinical intrastent thrombus or vulnerable stented segment.
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5
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Mitsuzuka K, Li Y, Nakayama T, Anzai H, Goanno D, Tupin S, Zhang M, Wang H, Horie K, Ohta M. A Parametric Study of Flushing Conditions for Improvement of Angioscopy Visibility. J Funct Biomater 2022; 13:jfb13020069. [PMID: 35735924 PMCID: PMC9224925 DOI: 10.3390/jfb13020069] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/24/2022] [Accepted: 05/27/2022] [Indexed: 02/01/2023] Open
Abstract
During an angioscopy operation, a transparent liquid called dextran is sprayed out from a catheter to flush the blood away from the space between the camera and target. Medical doctors usually inject dextran at a constant flow rate. However, they often cannot obtain clear angioscopy visibility because the flushing out of the blood is insufficient. Good flushing conditions producing clear angioscopy visibility will increase the rate of success of angioscopy operations. This study aimed to determine a way to improve the clarity for angioscopy under different values for the parameters of the injection waveform, endoscope position, and catheter angle. We also determined the effect of a stepwise waveform for injecting the dextran only during systole while synchronizing the waveform to the cardiac cycle. To evaluate the visibility of the blood-vessel walls, we performed a computational fluid dynamics (CFD) simulation and calculated the visible area ratio (VAR), representing the ratio of the visible wall area to the total area of the wall at each point in time. Additionally, the normalized integration of the VAR called the area ratio (ARVAR) represents the ratio of the visible wall area as a function of the dextran injection period. The results demonstrate that the ARVAR with a stepped waveform, bottom endoscope, and three-degree-angle catheter results in the highest visibility, around 25 times larger than that under the control conditions: a constant waveform, a center endoscope, and 0 degrees. This set of conditions can improve angioscopy visibility.
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Affiliation(s)
- Kohei Mitsuzuka
- Institute of Fluid Science, Tohoku University, 2-1-1 Katahira, Aoba-ku, Sendai 980-8577, Japan; (K.M.); (Y.L.); (H.A.); (D.G.); (S.T.); (M.Z.); (H.W.)
- Graduate School of Biomedical Engineering, Tohoku University, 6-6 Azaaoba, Aramaki, Aoba-ku, Sendai 980-8579, Japan
| | - Yujie Li
- Institute of Fluid Science, Tohoku University, 2-1-1 Katahira, Aoba-ku, Sendai 980-8577, Japan; (K.M.); (Y.L.); (H.A.); (D.G.); (S.T.); (M.Z.); (H.W.)
- Centre for Healthy Futures, Torrens University Australia, 1-51 Foveaux Street, Sydney, NSW 2010, Australia
| | - Toshio Nakayama
- National Institute of Technology, Nara College, 22 Yatacho, Yamatokoriyama 639-1080, Japan;
| | - Hitomi Anzai
- Institute of Fluid Science, Tohoku University, 2-1-1 Katahira, Aoba-ku, Sendai 980-8577, Japan; (K.M.); (Y.L.); (H.A.); (D.G.); (S.T.); (M.Z.); (H.W.)
| | - Daisuke Goanno
- Institute of Fluid Science, Tohoku University, 2-1-1 Katahira, Aoba-ku, Sendai 980-8577, Japan; (K.M.); (Y.L.); (H.A.); (D.G.); (S.T.); (M.Z.); (H.W.)
- Graduate School of Biomedical Engineering, Tohoku University, 6-6 Azaaoba, Aramaki, Aoba-ku, Sendai 980-8579, Japan
| | - Simon Tupin
- Institute of Fluid Science, Tohoku University, 2-1-1 Katahira, Aoba-ku, Sendai 980-8577, Japan; (K.M.); (Y.L.); (H.A.); (D.G.); (S.T.); (M.Z.); (H.W.)
| | - Mingzi Zhang
- Institute of Fluid Science, Tohoku University, 2-1-1 Katahira, Aoba-ku, Sendai 980-8577, Japan; (K.M.); (Y.L.); (H.A.); (D.G.); (S.T.); (M.Z.); (H.W.)
- Macquarie Medical School, Faculty of Medicine, Health, and Human Sciences, Macquarie University, 75 Talavera Rd., Sydney, NSW 2109, Australia
| | - Haoran Wang
- Institute of Fluid Science, Tohoku University, 2-1-1 Katahira, Aoba-ku, Sendai 980-8577, Japan; (K.M.); (Y.L.); (H.A.); (D.G.); (S.T.); (M.Z.); (H.W.)
| | - Kazunori Horie
- Department of Cardiology, Sendai Kousei Hospital, 4-15 Hirose, Aoba-ku, Sendai 980-0873, Japan;
| | - Makoto Ohta
- Institute of Fluid Science, Tohoku University, 2-1-1 Katahira, Aoba-ku, Sendai 980-8577, Japan; (K.M.); (Y.L.); (H.A.); (D.G.); (S.T.); (M.Z.); (H.W.)
- Correspondence: ; Tel.: +81-22-217-53-09
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Yamaji K, Iwanaga Y, Kawamura T, Fujita K, Yasuda M, Takase T, Hirase C, Ueno M, Nakazawa G. Plaque characteristics and prognosis in patients with peripheral arterial disease by angioscopic analysis. J Cardiol 2022; 80:94-100. [DOI: 10.1016/j.jjcc.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 01/11/2022] [Accepted: 01/29/2022] [Indexed: 10/19/2022]
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7
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Pitavastatin: Coronary Atherosclerotic Plaques Changes and Cardiovascular Prevention. High Blood Press Cardiovasc Prev 2022; 29:137-144. [DOI: 10.1007/s40292-021-00496-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 11/30/2021] [Indexed: 10/19/2022] Open
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8
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Higashino N, Ishihara T, Iida O, Tsujimura T, Hata Y, Toyoshima T, Kurata N, Asai M, Masuda M, Okamoto S, Nanto K, Kanda T, Matsuda Y, Mano T. Early- and Middle-Phase Angioscopic Assessment of Arterial Healing Following Current Drug-Eluting Stent Implantation in Patients With Acute Coronary Syndrome. Circ Rep 2021; 3:666-673. [PMID: 34805607 PMCID: PMC8578128 DOI: 10.1253/circrep.cr-21-0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 08/18/2021] [Indexed: 11/09/2022] Open
Abstract
Background: Drug-eluting stents (DESs) have been widely used for the treatment of acute coronary syndrome (ACS). However, there are few reports on early- and middle-phase arterial repair after DES implantation in ACS patients. Methods and Results: Coronary angioscopy (CAS) findings covering the early and middle phases (mean [±SD] 4±1 and 10±2 months, respectively) of arterial healing after second- and later-generation DES placement between May 2009 and January 2020 were extracted from the Kansai Rosai Hospital Cardiovascular Center database. Neointimal coverage (NIC), yellow color intensity, and the incidence of thrombus adhesion were compared between ACS and chronic coronary syndrome (CCS) in the early (54 stents of 47 lesions, 38 ACS patients; 86 stents of 70 lesions, 52 CCS patients) and middle (179 stents of 154 lesions from 136 ACS patients; 459 stents of 374 lesions from 287 CCS patients) phases. In the early phase, NIC, the incidence of thrombus adhesion (ACS, 39.1%; CCS, 38.0%), and maximum yellow color grade were similar between the 2 groups. In the middle phase, although the maximum yellow color grade was significantly higher in the ACS group (P=0.013), NIC and the incidence of thrombus adhesion (ACS, 24.6%; CCS, 23.4%) were similar in the 2 groups. Conclusions: Arterial healing assessment with CAS showed that NIC and the incidence of thrombus adhesion after DES implantation were similar between ACS and CCS patients.
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Affiliation(s)
| | | | - Osamu Iida
- Kansai Rosai Hospital Cardiovascular Center Amagasaki Japan
| | | | - Yosuke Hata
- Kansai Rosai Hospital Cardiovascular Center Amagasaki Japan
| | - Taku Toyoshima
- Kansai Rosai Hospital Cardiovascular Center Amagasaki Japan
| | - Naoya Kurata
- Department of Clinical Engineering, Kansai Rosai Hospital Amagasaki Japan
| | | | | | - Shin Okamoto
- Kansai Rosai Hospital Cardiovascular Center Amagasaki Japan
| | - Kiyonori Nanto
- Kansai Rosai Hospital Cardiovascular Center Amagasaki Japan
| | - Takashi Kanda
- Kansai Rosai Hospital Cardiovascular Center Amagasaki Japan
| | | | - Toshiaki Mano
- Kansai Rosai Hospital Cardiovascular Center Amagasaki Japan
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Yamaguchi T, Yamazaki T, Yoshida H, Hayashi O, Yahiro R, Nakao K, Okai T, Ehara S, Izumiya Y, Yoshiyama M. Angioscopic Ulcerated Plaques in the Femoropopliteal Artery Associated with Impaired Infrapopliteal Runoff. J Vasc Interv Radiol 2021; 33:97-103.e1. [PMID: 34715323 DOI: 10.1016/j.jvir.2021.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 10/15/2021] [Accepted: 10/17/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To determine the correlation between upstream atherosclerosis in the femoropopliteal arteries, assessed using angioscopy, and impaired infrapopliteal runoff. MATERIALS AND METHODS Thirty-one patients with peripheral arterial disease who underwent endovascular therapy and angioscopy were prospectively included. Yellow plaque color scores were semiquantitatively determined as 0, 1, 2, or 3. Irregular plaques with rough surfaces, similar to gastric ulcers, were defined as ulcerated plaques (UPs). Angioscopic data were correlated with angiographic runoff scores (ARS). RESULTS UPs were detected in 74.2% of enrolled diseased legs using angioscopy. Mural thrombi were more commonly observed in the femoropopliteal artery in patients with UPs than in those without UPs (91.3% vs 37.5%, respectively; P = .006) and were frequently found on the UPs (21/23 patients with UPs). Univariate and multivariate linear regression analyses revealed that the presence of UPs was positively and independently associated with a poor ARS and that oral anticoagulant use was independently associated with a preferable ARS (standardized β = 0.462, P = .004 and standardized β = -0.411, P = .009, respectively, in the multivariate analysis). CONCLUSIONS UPs, associated with mural thrombi and diagnosed by angioscopic examination, were demonstrated to be one of the factors associated with poor infrapopliteal runoff.
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Affiliation(s)
- Tomohiro Yamaguchi
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Takanori Yamazaki
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan.
| | - Hisako Yoshida
- Department of Medical Statistics, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Ou Hayashi
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Ryosuke Yahiro
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kazuhiro Nakao
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Tsukasa Okai
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shoichi Ehara
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yasuhiro Izumiya
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Minoru Yoshiyama
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
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10
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Sriranjan RS, Tarkin JM, Evans NR, Le EPV, Chowdhury MM, Rudd JHF. Atherosclerosis imaging using PET: Insights and applications. Br J Pharmacol 2021; 178:2186-2203. [PMID: 31517992 DOI: 10.1111/bph.14868] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 08/02/2019] [Accepted: 08/16/2019] [Indexed: 12/17/2022] Open
Abstract
PET imaging is able to harness biological processes to characterise high-risk features of atherosclerotic plaque prone to rupture. Current radiotracers are able to track inflammation, microcalcification, hypoxia, and neoangiogenesis within vulnerable plaque. 18 F-fluorodeoxyglucose (18 F-FDG) is the most commonly used radiotracer in vascular studies and is employed as a surrogate marker of plaque inflammation. Increasingly, 18 F-FDG and other PET tracers are also being used to provide imaging endpoints in cardiovascular interventional trials. The evolution of novel PET radiotracers, imaging protocols, and hybrid scanners are likely to enable more efficient and accurate characterisation of high-risk plaque. This review explores the role of PET imaging in atherosclerosis with a focus on PET tracers utilised in clinical research and the applications of PET imaging to cardiovascular drug development.
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Affiliation(s)
| | - Jason M Tarkin
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK
| | - Nicholas R Evans
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK
| | - Elizabeth P V Le
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK
| | | | - James H F Rudd
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK
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11
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Tsujimura T, Ishihara T, Iida O, Hata Y, Toyoshima T, Higashino N, Kurata N, Asai M, Masuda M, Okamoto S, Nanto K, Kanda T, Matsuda Y, Mano T. Arterial Healing 10 Months After Implantation of an Ultrathin-Strut, Biodegradable-Polymer, Sirolimus-Eluting Stent - An Angioscopic Study. Circ Rep 2021; 3:316-323. [PMID: 34136706 PMCID: PMC8180372 DOI: 10.1253/circrep.cr-21-0053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background:
The OrsiroTM
ultrathin-strut, biodegradable-polymer, sirolimus-eluting stent (O-SES) has specific characteristics regarding its components and has demonstrated comparable clinical outcomes compared with durable-polymer, drug-eluting stents (DES). However, arterial repair following deployment of the O-SES has not been elucidated to date. Methods and Results:
Using data from the Kansai Rosai Hospital database between November 2010 and September 2020, we analyzed coronary angioscopy (CAS) findings a mean (±SD) of 10±2 months after implantation of an O-SES, a durable-polymer everolimus-eluting stent (XienceTM; X-EES), or a biodegradable-polymer everolimus-eluting stent (SynergyTM; S-EES). Neointimal coverage (NIC), yellow color intensity of the stented segment, and the incidence of thrombus adhesion were compared between the O-SES (66 stents from 42 patients), X-EES (119 stents from 87 patients), and S-EES (132 stents from 88 patients). NIC was significantly thinner for the O-SES than S-EES (P<0.001), but was similar between the O-SES and X-EES (P=0.25). Yellow color intensity was significantly greater for the O-SES than X-EES (P<0.001), but similar between the O-SES and S-EES (P=0.51). The incidence of thrombus adhesions was similar in all 3 groups. Conclusions:
O-SES and X-EES resulted in similar inhibition of NIC and both resulted in a thinner NIC than with S-EES. In addition, O-SES exhibited a similar degree of thrombus adhesion as the other DES, suggesting similar thrombogenicity.
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Affiliation(s)
| | | | - Osamu Iida
- Kansai Rosai Hospital Cardiovascular Center Amagasaki Japan
| | - Yosuke Hata
- Kansai Rosai Hospital Cardiovascular Center Amagasaki Japan
| | - Taku Toyoshima
- Kansai Rosai Hospital Cardiovascular Center Amagasaki Japan
| | | | - Naoya Kurata
- Department of Clinical Engineering, Kansai Rosai Hospital Amagasaki Japan
| | | | | | - Shin Okamoto
- Kansai Rosai Hospital Cardiovascular Center Amagasaki Japan
| | - Kiyonori Nanto
- Kansai Rosai Hospital Cardiovascular Center Amagasaki Japan
| | - Takashi Kanda
- Kansai Rosai Hospital Cardiovascular Center Amagasaki Japan
| | | | - Toshiaki Mano
- Kansai Rosai Hospital Cardiovascular Center Amagasaki Japan
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Mitsutake Y, Yano H, Ishihara T, Matsuoka H, Ueda Y, Ueno T. Consensus document on the standard of coronary angioscopy examination and assessment from the Japanese Association of Cardiovascular Intervention and Therapeutics. Cardiovasc Interv Ther 2021; 37:35-39. [PMID: 33743168 DOI: 10.1007/s12928-021-00770-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 03/12/2021] [Indexed: 11/24/2022]
Abstract
Coronary angioscopy (CAS) is a unique diagnostic device that allows direct visualization of the vascular luminal surface in living patients. CAS contributes to elucidate the pathology of coronary artery disease. This consensus document provides a standard for CAS examination and assessment.
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Affiliation(s)
- Yoshiaki Mitsutake
- Division of Cardiovascular Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan.
| | - Hideto Yano
- Division of Cardiology, Gyotoku General Hospital, Chiba, Japan
| | | | - Hiroshi Matsuoka
- Department of General Medicine, Ehime Prefectural Central Hospital, Ehime, Japan
| | - Yasunori Ueda
- Cardiovascular Division, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Takafumi Ueno
- Division of Cardiology, Fukuoka Memorial Hospital, Fukuoka, Japan
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13
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Yamaguchi M, Sugiyama T, Hoshino M, Kanaji Y, Hada M, Usui E, Yonetsu T, Kakuta T. Two distinct phenotypes of plaque erosion assessed by multimodality intracoronary imaging: a case series. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 4:1-5. [PMID: 32128487 PMCID: PMC7047054 DOI: 10.1093/ehjcr/ytz241] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/17/2019] [Accepted: 12/19/2019] [Indexed: 11/18/2022]
Abstract
Background Pathological studies have reported that patients with acute coronary syndrome (ACS) may have different plaque morphologies at culprit lesions, and one of the underlying mechanisms for ACS is plaque erosion. However, the morphological features of plaque erosion obtained by multiple intracoronary imaging modalities have not been fully elucidated. Case summary We experienced two cases with ACS of culprit lesions exhibiting optical coherence tomography (OCT)-defined plaque erosion. Additional examinations using near-infrared spectroscopy (NIRS)–intravascular ultrasound and coronary angioscopy suggested the presence of two distinct phenotypes of plaque erosion. These two types of erosion differ in the extent of NIRS-derived lipid core burden and coronary angioscopy-derived luminal surface colour. Discussion OCT-defined plaque erosion may not be the unique entity but have at least two distinct plaque morphologies, and NIRS and/or coronary angioscopy may provide incremental ability of discriminating these plaque phenotypes classified as plaque erosion by OCT.
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Affiliation(s)
- Masao Yamaguchi
- Department of Cardiology, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura City, Ibaraki 300-0028, Japan
| | - Tomoyo Sugiyama
- Department of Cardiology, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura City, Ibaraki 300-0028, Japan
| | - Masahiro Hoshino
- Department of Cardiology, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura City, Ibaraki 300-0028, Japan
| | - Yoshihisa Kanaji
- Department of Cardiology, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura City, Ibaraki 300-0028, Japan
| | - Masahiro Hada
- Department of Cardiology, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura City, Ibaraki 300-0028, Japan
| | - Eisuke Usui
- Department of Cardiology, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura City, Ibaraki 300-0028, Japan
| | - Taishi Yonetsu
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo Ward, Tokyo 113-8519, Japan
| | - Tsunekazu Kakuta
- Department of Cardiology, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura City, Ibaraki 300-0028, Japan
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14
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He W, Zhu L, Huang Y, Zhang Y, Shen W, Fang L, Li J, Wang Z, Xie Q. The relationship of MicroRNA-21 and plaque stability in acute coronary syndrome. Medicine (Baltimore) 2019; 98:e18049. [PMID: 31764830 PMCID: PMC6882643 DOI: 10.1097/md.0000000000018049] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Acute coronary syndrome (ACS) leads to clinical symptoms such as chest pain, dyspnea, and arrhythmia. The occurrence of ACS is mainly related to the vulnerable plaques in the coronary arteries. MicroRNA-21 (miR-21) is widely expressed in cardiovascular disease and considered as a marker of myocardial infarction, but its role in vulnerable atherosclerotic plaque of ACS is poorly studied. The cases of ACS and control group were selected in 2 years. Our results revealed that miR-21 was highly positively correlated with the maximum lipid core area, the number of diseased vessels, the number of macrophages, the number of vulnerable plaques, and negatively correlated with the thickness of fiber caps. In the high expression group, the number of coronary artery lesions, the number of vulnerable plaques, the core area of lipid pools and the number of macrophages were significantly higher than those in the low expression group and the middle expression group. But the high expression group of the thickness of the fiber cap was significantly lower than that of the low expression group and the medium expression group. These studies show that miR-21 is an important factor leading to vulnerable plaque instability in ACS, and it can be a predictor of acute adverse events in coronary heart disease.
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Affiliation(s)
- Wangwei He
- Department of Cardiology, the First Affiliated Hospital of Xiamen University, Xiamen, Fujian Province
| | - Liyuan Zhu
- Department of Cardiology, the First Affiliated Hospital of Xiamen University, Xiamen, Fujian Province
| | - Yu Huang
- Department of Cardiology, the First Affiliated Hospital of Xiamen University, Xiamen, Fujian Province
| | - Yinfen Zhang
- Department of Cardiology, the First Affiliated Hospital of Xiamen University, Xiamen, Fujian Province
| | - Weimin Shen
- Department of Cardiology, the First Affiliated Hospital of Xiamen University, Xiamen, Fujian Province
| | - Lihuan Fang
- Department of Cardiology, the First Affiliated Hospital of Xiamen University, Xiamen, Fujian Province
| | - Jun Li
- Department of Cardiology, the First Affiliated Hospital of Xiamen University, Xiamen, Fujian Province
| | - Zhuo Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute of Wuhan University, Wuhan, Hubei Province, China
| | - Qiang Xie
- Department of Cardiology, the First Affiliated Hospital of Xiamen University, Xiamen, Fujian Province
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15
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Kondo H, Kiura Y, Sakamoto S, Okazaki T, Yamasaki F, Iida K, Tominaga A, Kurisu K. Comparative Evaluation of Angioscopy and Intravascular Ultrasound for Assessing Plaque Protrusion During Carotid Artery Stenting Procedures. World Neurosurg 2019; 125:e448-e455. [DOI: 10.1016/j.wneu.2019.01.102] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 01/18/2019] [Accepted: 01/19/2019] [Indexed: 11/25/2022]
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16
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Sato S, Miyake N. [Optimal Conditions for 3D Non-contrast T 1-weighted Magnetic Resonance Imaging Segmented Turbo Fast Low-angle Shot for Tissue Characterization of Coronary Plaques]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2018; 74:48-60. [PMID: 29353836 DOI: 10.6009/jjrt.2018_jsrt_74.1.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In three-dimensional (3D) T1-weighted magnetic resonance imaging used for tissue characterization of coronary plaques, the contrast for electrocardiographic synchronization may vary according to the R-R interval (RR). The coronary artery plaque image shows suppression of the fluid compartment signal for the coronary artery luminal blood as well as the fat signal in the region of interest; in addition, it is necessary to ensure that the value of the plaque-to-muscle signal intensity ratio (PMR) does not change according to the difference in RR. In the current study, the phantom review and clinical data suggested that the PMR changes that occur due to the differences in RR can be minimized by adjusting the inversion time (TI) in the range of the required black blood effect. Moreover, the signal-to-noise ratio (SNR), which varies according to the difference between the RR and the TI, was determined to identify the maximum value flip angle (FA) value that would lead to improvement in the SNR. Thus, signal suppression of the PMR, SNR, and the fluid compartment of the coronary artery luminal blood can be controlled using different RRs with the relational expressions for calculating optimal TI and FA.
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Affiliation(s)
- Satoru Sato
- Department of Radiology, Ehime Prefectural Imabari Hospital
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17
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Negishi Y, Ishii H, Suzuki S, Aoki T, Iwakawa N, Kojima H, Harada K, Hirayama K, Mitsuda T, Sumi T, Tanaka A, Ogawa Y, Kawaguchi K, Murohara T. The combination assessment of lipid pool and thrombus by optical coherence tomography can predict the filter no-reflow in primary PCI for ST elevated myocardial infarction. Medicine (Baltimore) 2017; 96:e9297. [PMID: 29390391 PMCID: PMC5815803 DOI: 10.1097/md.0000000000009297] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The usefulness of distal protection devices is still controversial. Moreover, there is no report on thrombus evaluation by using optical coherence tomography (OCT) for determining whether to use a distal protection device. The aim of the present study was to investigate the predictor of filter no-reflow (FNR) by using OCT in primary percutaneous coronary intervention (PCI) for ST-elevated acute myocardial infarction (STEMI).We performed preinterventional OCT in 25 patients with STEMI who were undergoing primary PCI with Filtrap. FNR was defined as coronary flow decreasing to TIMI flow grade 0 after mechanical dilatation.FNR was observed in 13 cases (52%). In the comparisons between cases with or without the FNR, the stent length, lipid pool length, lipid pool + thrombus length, and lipid pool + thrombus index showed significant differences. In multivariate analysis, lipid pool + thrombus length was the only independent predictor of FNR (OR 1.438, 95% CI 1.001 - 2.064, P < .05). The optimal cut-off value of lipid pool + thrombus length for predicting FNR was 13.1 mm (AUC = 0.840, sensitivity 76.9%, specificity 75.0%). Moreover, when adding the evaluation of thrombus length to that of lipid pool length, the prediction accuracy of FNR further increased (IDI 0.14: 0.019-0.25, P = .023).The longitudinal length of the lipid pool plus thrombus was an independent predictor of FNR and the prediction accuracy improved by adding the thrombus to the lipid pool. These results might be useful for making intraoperative judgment about whether filter devices should be applied in primary PCI for STEMI.
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Affiliation(s)
- Yosuke Negishi
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Susumu Suzuki
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toshijiro Aoki
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Iwakawa
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroki Kojima
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuhiro Harada
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenshi Hirayama
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takayuki Mitsuda
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takuya Sumi
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akihito Tanaka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiro Ogawa
- Department of Cardiology, Komaki City Hospital, Aichi, Japan
| | | | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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18
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Mintz GS, Guagliumi G. Intravascular imaging in coronary artery disease. Lancet 2017; 390:793-809. [PMID: 28831995 DOI: 10.1016/s0140-6736(17)31957-8] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 06/27/2017] [Accepted: 07/05/2017] [Indexed: 12/15/2022]
Abstract
Although it is the method used by most interventional cardiologists to assess the severity of coronary artery disease and guide treatment, coronary angiography has many known limitations, particularly the fact that it is a lumenogram depicting foreshortened, shadowgraph, planar projections of the contrast-filled lumen rather than imaging the diseased vessel itself. Intravascular imaging-intravascular ultrasound and more recently optical coherence tomography-provide a tomographical or cross-sectional image of the coronary arteries. These techniques are clinically useful to answer questions such as whether the stenosis is clinically relevant; the identification of the culprit lesion; or whether the plaque (or patient) is at high risk of future adverse events. They can also be used to optimise stent implantation to minimise stent-related adverse events, provide answers to the likelihood of distal embolisation or peri-procedural myocardial infarction during stent implantation, and provide reasons for stent thrombosis or restenosis. This review considers the usefulness of intravascular imaging in day-to-day practice.
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Affiliation(s)
- Gary S Mintz
- Cardiovascular Research Foundation, New York, NY, USA.
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19
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Mintz GS. Predicting the Vulnerable Patient Using Intravascular Imaging ∗. J Am Coll Cardiol 2017; 69:2514-2516. [DOI: 10.1016/j.jacc.2017.03.555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 03/16/2017] [Indexed: 10/19/2022]
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20
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Uchida Y, Uchida Y, Kobayashi T, Shirai S, Hiruta N, Shimoyama E, Tabata T. Detection of Ceramide, a Risk Factor for Coronary Artery Disease, in Human Coronary Plaques by Fluorescent Angioscopy. Circ J 2017; 81:1886-1893. [DOI: 10.1253/circj.cj-17-0363] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | | | - Nobuyuki Hiruta
- Department of Pathology, Toho University Medical Center Sakura Hospital
| | - Ei Shimoyama
- Department of Pathology, Funabashi-Futawa Hospital
| | - Tsuyoshi Tabata
- Department of Clinical Physiology, Toho University Medical Center Sakura Hospital
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21
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Abstract
Coronary artery disease is the result of atherosclerotic changes to the coronary arterial wall, comprising endothelial dysfunction, vascular inflammation and deposition of lipid-rich macrophage foam cells. Certain high-risk atherosclerotic plaques are vulnerable to disruption, leading to rupture, thrombosis and the clinical sequelae of acute coronary syndrome. Though recognised as the gold standard for evaluating the presence, distribution and severity of atherosclerotic lesions, invasive coronary angiography is incapable of identifying non-stenotic, vulnerable plaques that are responsible for adverse cardiovascular events. The recognition of such limitations has impelled the development of intracoronary imaging technologies, including intravascular ultrasound, optical coherence tomography and near-infrared spectroscopy, which enable the detailed evaluation of the coronary wall and atherosclerotic plaques in clinical practice. This review discusses the present status of invasive imaging technologies; summarises up-to-date, evidence-based clinical guidelines; and addresses questions that remain unanswered with regard to the future of intracoronary plaque imaging.
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Affiliation(s)
- Jonathan A Batty
- Institute of Cellular Medicine, Newcastle University, 3rd Floor, William Leech Building, Newcastle Upon Tyne, NE2 4HH, UK. .,Freeman Hospital, Newcastle Upon Tyne NHS Foundation Trust, Newcastle Upon Tyne, NE7 7DN, UK.
| | - Shristy Subba
- Institute of Cellular Medicine, Newcastle University, 3rd Floor, William Leech Building, Newcastle Upon Tyne, NE2 4HH, UK.
| | - Peter Luke
- Freeman Hospital, Newcastle Upon Tyne NHS Foundation Trust, Newcastle Upon Tyne, NE7 7DN, UK.
| | - Li Wing Chi Gigi
- Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China.
| | - Hannah Sinclair
- Institute of Cellular Medicine, Newcastle University, 3rd Floor, William Leech Building, Newcastle Upon Tyne, NE2 4HH, UK. .,Freeman Hospital, Newcastle Upon Tyne NHS Foundation Trust, Newcastle Upon Tyne, NE7 7DN, UK.
| | - Vijay Kunadian
- Institute of Cellular Medicine, Newcastle University, 3rd Floor, William Leech Building, Newcastle Upon Tyne, NE2 4HH, UK. .,Freeman Hospital, Newcastle Upon Tyne NHS Foundation Trust, Newcastle Upon Tyne, NE7 7DN, UK.
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22
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Honda S, Kataoka Y, Kanaya T, Noguchi T, Ogawa H, Yasuda S. Characterization of coronary atherosclerosis by intravascular imaging modalities. Cardiovasc Diagn Ther 2016; 6:368-81. [PMID: 27500094 DOI: 10.21037/cdt.2015.12.05] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Coronary artery disease (CAD) is highly prevalent in Western countries and is associated with morbidity, mortality, and a significant economic burden. Despite the development of anti-atherosclerotic medical therapies, many patients still continue to suffer from coronary events. This residual risk indicates the need for better risk stratification and additional therapies to achieve more reductions in cardiovascular risk. Recent advances in imaging modalities have contributed to visualizing atherosclerotic plaques and defining lesion characteristics in vivo. This innovation has been applied to refining revascularization procedure, assessment of anti-atherosclerotic drug efficacy and the detection of high-risk plaques. As such, intravascular imaging plays an important role in further improvement of cardiovascular outcomes in patients with CAD. The current article reviews available intravascular imaging modalities with regard to its method, advantage and disadvantage.
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Affiliation(s)
- Satoshi Honda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan; ; Department of Advanced Cardiovascular Medicine, Graduated School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Yu Kataoka
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Tomoaki Kanaya
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hisao Ogawa
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan; ; Department of Cardiovascular Medicine, Graduated School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan; ; Department of Advanced Cardiovascular Medicine, Graduated School of Medical Science, Kumamoto University, Kumamoto, Japan
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23
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Pathan F, Negishi K. Prediction of cardiovascular outcomes by imaging coronary atherosclerosis. Cardiovasc Diagn Ther 2016; 6:322-39. [PMID: 27500091 DOI: 10.21037/cdt.2015.12.08] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Over the last two decades, several invasive and non-invasive coronary atherosclerosis imaging modalities have emerged as predictors of cardiovascular outcomes in at-risk population. These modalities have demonstrated independent or incremental prognostic information over existing/standard risk stratification schemes, such as the Framingham risk score (FRS), by identifying characteristics of coronary artery diseases (CADs). In this review, we begin with discussing the importance of pre-test probability and quality of outcome measure, followed by specific findings of each modality in relation to prognosis. We focused on both short and long term prognostic aspects of coronary computed tomography (CT) (including coronary calcium score and coronary angiography) and magnetic resonance imaging as non-invasive tools, as well as invasive modalities including intravascular ultrasound (IVUS), optical coherence tomography (OCT), near infrared spectroscopy and Angioscopy.
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Affiliation(s)
- Faraz Pathan
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Kazuaki Negishi
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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24
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Ueda Y. Angioscopy in 2015: the Role of Macroscopic Pathology in Living Patients. CURRENT CARDIOVASCULAR IMAGING REPORTS 2016. [DOI: 10.1007/s12410-015-9367-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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25
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Goel S, Miller A, Agarwal C, Zakin E, Acholonu M, Gidwani U, Sharma A, Kulbak G, Shani J, Chen O. Imaging Modalities to Identity Inflammation in an Atherosclerotic Plaque. Radiol Res Pract 2015; 2015:410967. [PMID: 26798515 PMCID: PMC4699110 DOI: 10.1155/2015/410967] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 11/19/2015] [Indexed: 11/18/2022] Open
Abstract
Atherosclerosis is a chronic, progressive, multifocal arterial wall disease caused by local and systemic inflammation responsible for major cardiovascular complications such as myocardial infarction and stroke. With the recent understanding that vulnerable plaque erosion and rupture, with subsequent thrombosis, rather than luminal stenosis, is the underlying cause of acute ischemic events, there has been a shift of focus to understand the mechanisms that make an atherosclerotic plaque unstable or vulnerable to rupture. The presence of inflammation in the atherosclerotic plaque has been considered as one of the initial events which convert a stable plaque into an unstable and vulnerable plaque. This paper systemically reviews the noninvasive and invasive imaging modalities that are currently available to detect this inflammatory process, at least in the intermediate stages, and discusses the ongoing studies that will help us to better understand and identify it at the molecular level.
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Affiliation(s)
- Sunny Goel
- Department of Medicine, Maimonides Medical Center, Brooklyn, NY 11219, USA
| | - Avraham Miller
- Department of Medicine, Maimonides Medical Center, Brooklyn, NY 11219, USA
| | - Chirag Agarwal
- Department of Medicine, Maimonides Medical Center, Brooklyn, NY 11219, USA
| | - Elina Zakin
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Michael Acholonu
- Department of Medicine, Maimonides Medical Center, Brooklyn, NY 11219, USA
| | - Umesh Gidwani
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Abhishek Sharma
- Division of Cardiovascular Medicine, State University of New York Downstate Medical Centre, Brooklyn, NY 11203, USA
| | - Guy Kulbak
- Department of Cardiology, Maimonides Medical Center, Brooklyn, NY 11219, USA
| | - Jacob Shani
- Department of Cardiology, Maimonides Medical Center, Brooklyn, NY 11219, USA
| | - On Chen
- Department of Cardiology, Maimonides Medical Center, Brooklyn, NY 11219, USA
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26
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Matsuo Y, Kubo T, Aoki H, Satogami K, Ino Y, Kitabata H, Taruya A, Nishiguchi T, Teraguchi I, Shimamura K, Shiono Y, Orii M, Yamano T, Tanimoto T, Yamaguchi T, Hirata K, Tanaka A, Akasaka T. Optimal threshold of postintervention minimum stent area to predict in-stent restenosis in small coronary arteries: An optical coherence tomography analysis. Catheter Cardiovasc Interv 2015; 87:E9-E14. [DOI: 10.1002/ccd.26143] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 07/17/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Yoshiki Matsuo
- Department of Cardiovascular Medicine; Wakayama Medical University; Wakayama Japan
| | - Takashi Kubo
- Department of Cardiovascular Medicine; Wakayama Medical University; Wakayama Japan
| | - Hiroshi Aoki
- Department of Cardiovascular Medicine; Wakayama Medical University; Wakayama Japan
| | - Keisuke Satogami
- Department of Cardiovascular Medicine; Wakayama Medical University; Wakayama Japan
| | - Yasushi Ino
- Department of Cardiovascular Medicine; Wakayama Medical University; Wakayama Japan
| | - Hironori Kitabata
- Department of Cardiovascular Medicine; Wakayama Medical University; Wakayama Japan
| | - Akira Taruya
- Department of Cardiovascular Medicine; Wakayama Medical University; Wakayama Japan
| | - Tsuyoshi Nishiguchi
- Department of Cardiovascular Medicine; Wakayama Medical University; Wakayama Japan
| | - Ikuko Teraguchi
- Department of Cardiovascular Medicine; Wakayama Medical University; Wakayama Japan
| | - Kunihiro Shimamura
- Department of Cardiovascular Medicine; Wakayama Medical University; Wakayama Japan
| | - Yasutsugu Shiono
- Department of Cardiovascular Medicine; Wakayama Medical University; Wakayama Japan
| | - Makoto Orii
- Department of Cardiovascular Medicine; Wakayama Medical University; Wakayama Japan
| | - Takashi Yamano
- Department of Cardiovascular Medicine; Wakayama Medical University; Wakayama Japan
| | - Takashi Tanimoto
- Department of Cardiovascular Medicine; Wakayama Medical University; Wakayama Japan
| | - Tomoyuki Yamaguchi
- Department of Cardiovascular Medicine; Wakayama Medical University; Wakayama Japan
| | - Kumiko Hirata
- Department of Cardiovascular Medicine; Wakayama Medical University; Wakayama Japan
| | - Atsushi Tanaka
- Department of Cardiovascular Medicine; Wakayama Medical University; Wakayama Japan
| | - Takashi Akasaka
- Department of Cardiovascular Medicine; Wakayama Medical University; Wakayama Japan
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27
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Serial changes of coronary endothelial function and arterial healing after paclitaxel-eluting stent implantation. Cardiovasc Interv Ther 2015; 31:21-8. [DOI: 10.1007/s12928-015-0341-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 06/16/2015] [Indexed: 11/30/2022]
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28
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In-Stent Yellow Plaque at 1 Year After Implantation Is Associated With Future Event of Very Late Stent Failure. JACC Cardiovasc Interv 2015; 8:814-821. [DOI: 10.1016/j.jcin.2014.12.239] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Revised: 12/05/2014] [Accepted: 12/18/2014] [Indexed: 11/23/2022]
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29
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Aono J, Ikeda S, Katsumata Y, Higashi H, Ohshima K, Ishibashi K, Matsuoka H, Watanabe K, Hamada M. Correlation between plaque vulnerability of aorta and coronary artery: an evaluation of plaque activity by direct visualization with angioscopy. Int J Cardiovasc Imaging 2015; 31:1107-14. [PMID: 25916323 PMCID: PMC4486772 DOI: 10.1007/s10554-015-0669-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 04/21/2015] [Indexed: 11/05/2022]
Abstract
This study investigated the relationship between the degree of atherosclerotic changes in the descending thoracic aorta (TA) and the coronary artery using angioscopy. Twenty-five consecutive patients undergoing angioscopy of the TA and coronary angiography were enrolled in this study. Participants were divided into three groups according to the angioscopic grading of the TA: white plaque group (W-group), yellow plaque group (Y-group) and intensive yellow, ruptured plaque with ulceration and/or thrombus group (RP-group). The maximum plaque grade, plaque score, number of yellow plaques, frequency of yellow-plaque grades by coronary angioscopy, and SYNTAX score by coronary angiography were evaluated. Brachial-artery pulse wave velocity and high-sensitivity C-reactive protein level tended to be higher in the RP-group than in the other groups, although the differences were not statistically significant. The SYNTAX score was significantly higher in the RP-group than in the W-group (W-group 4.0 ± 3.6 vs. RP-group 17.5 ± 10.0, P = 0.045). In addition, the angioscopic maximum plaque grade, plaque score, and number of yellow plaques in the RP-group were significantly higher than in the W-group (maximum plaque grade W-group 0.8 ± 0.4 vs. RP-group 1.8 ± 0.8, P = 0.026; plaque score W-group 1.0 ± 1.2 vs. RP-group 4.0 ± 1.4, P = 0.014; and number of yellow plaques W-group 1.0 ± 1.2 vs. RP-group 2.5 ± 0.5, P = 0.023). The yellow-plaque grade in the coronary artery was correlated significantly with the plaque grading of TA (P = 0.043). Our study suggests that the angioscopic progression of aortic atherosclerosis is closely associated with vulnerability to and the extent of coronary stenosis, indicating that vulnerability toward atherosclerotic plaque development occurs simultaneously in the coronary tree and systemic arteries.
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Affiliation(s)
- Jun Aono
- Division of Cardiology, Kitaishikai Hospital, Tokunomori, Ozu, Ehime, Japan
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Roleder T, Kovacic JC, Ali Z, Sharma R, Cristea E, Moreno P, Sharma SK, Narula J, Kini AS. Combined NIRS and IVUS imaging detects vulnerable plaque using a single catheter system: a head-to-head comparison with OCT. EUROINTERVENTION 2015; 10:303-11. [PMID: 24769522 DOI: 10.4244/eijv10i3a53] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The presence of thin-cap fibroatheromas (TCFA) is associated with high risk of acute coronary syndrome, hence their early detection may identify high-risk patients. In the present study we investigated the ability of a combined imaging catheter with near-infrared spectroscopy (NIRS) plus intravascular ultrasound (IVUS) to detect TCFA in patients with stable coronary artery disease. METHODS AND RESULTS Optical coherence tomography (OCT) and combined NIRS-IVUS assessment were performed on identical coronary segments. IVUS analysis provided per-segment minimal cross-sectional area (CSA), plaque length (PL), plaque burden (PB), plaque volume (PV), and remodelling index (RI). OCT was used as the gold-standard reference to define TCFA (fibrous cap thickness <65 μm). Plaque lipid content was estimated by NIRS (lipid core burden index [LCBI]). OCT-defined TCFA was present in 18 of 76 segments. IVUS revealed that OCT-defined TCFA were positively remodelled lesions with greater PB and PV, smaller CSA, and longer PL, while NIRS revealed greater LCBI per 2 mm segment (LCBI2mm) (all p<0.001). Greatest accuracy for OCT-defined TCFA detection was achieved using LCBI2mm >315 with RI >1.046 as a combined criterion value. CONCLUSIONS OCT-defined TCFA are characterised by positive vessel remodelling, high plaque burden and greater lipid core burden as assessed by dual NIRS-IVUS imaging.
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Affiliation(s)
- Tomasz Roleder
- Mount Sinai Medical Center and Mount Sinai School of Medicine, New York, NY, USA
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31
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Kurihara O, Takano M, Seino Y, Shimizu W, Mizuno K. Coronary atherosclerosis is already ongoing in pre-diabetic status: Insight from intravascular imaging modalities. World J Diabetes 2015; 6:184-191. [PMID: 25685289 PMCID: PMC4317311 DOI: 10.4239/wjd.v6.i1.184] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 10/22/2014] [Accepted: 12/17/2014] [Indexed: 02/05/2023] Open
Abstract
Diabetes mellitus is a powerful risk factor of coronary artery disease (CAD), leading to death and disability. In recent years, given the accumulating evidence that prediabetes is also related to increasing risk of CAD including cardiovascular events, a new guideline has been proposed for the treatment of blood cholesterol for primary prevention of cardiovascular events. This guideline recommends aggressive lipid-lowering statin therapy for primary prevention in diabetes and other patients. The ultimate goal of patient management is to inhibit progression of systemic atherosclerosis and prevent fatal cardiovascular events such as acute coronary syndrome (ACS). Because disruption of atherosclerotic coronary plaques is a trigger of ACS, the high-risk atheroma is called a vulnerable plaque. Several types of novel diagnostic imaging technologies have been developed for identifying the characteristics of coronary atherosclerosis before the onset of ACS, especially vulnerable plaques. According to coronary angioscopic evaluation, atherosclerosis severity and plaque vulnerability were more advanced in prediabetic than in nondiabetic patients and comparable to that in diabetic patients. In addition, pharmacological intervention by statin therapy changed plaque color and complexity, and the dynamic changes in plaque features are considered plaque stabilization. In this article, we review the findings of atherosclerosis in prediabetes, detected by intravascular imaging modalities, and the therapeutic implications.
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Ueda Y, Matsuo K, Nishimoto Y, Sugihara R, Hirata A, Takeda Y, Nemoto T, Okada M, Ueno K, Miyamoto Y, Lee K, Kojima T, Takahashi K, Amiya R, Kashiwase K, Kodama K. The importance of intracoronary imaging when we speculate long-term outcome of new intracoronary stents. ACTA ACUST UNITED AC 2015. [DOI: 10.15791/angioscopy.re.15.0003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | | | | | | | - Akio Hirata
- Cardiovascular Division, Osaka Police Hospital
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Kubo T, Tanaka A, Ino Y, Kitabata H, Shiono Y, Akasaka T. Assessment of coronary atherosclerosis using optical coherence tomography. J Atheroscler Thromb 2014; 21:895-903. [PMID: 25069815 DOI: 10.5551/jat.25452] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Optical coherence tomography (OCT) is a catheter-based imaging system that uses near-infrared light to produce cross-sectional images of the coronary arteries. With its extraordinarily high resolution (10-20 μm), OCT allows clinicians to observe various morphological features of coronary atherosclerosis in vivo. For example, intimal thickening presents as homogeneous, signal-rich regions on OCT, while fibroatheroma with a lipid-rich necrotic core is characterized by the presence of signal-poor regions with a diffuse border. Furthermore, plaque rupture is detected in 50〜70% of culprit lesions of acute coronary syndrome (ACS), and plaque erosion develops over areas of intimal thickening and/or thick-cap fibroatheroma. Meanwhile, calcified nodules are common in older patients with hypertension and chronic renal disease. Platelet-rich thrombi are visualized as low backscattering structures and often detected in patients with unstable angina, whereas red blood cell-rich thrombi exhibit a high backscattering structure with signal-free shadowing and are frequently noted in patients with acute myocardial infarction. Moreover, OCT-derived thin cap fibroatheroma has been shown to be a predictor of subsequent plaque progression and acute coronary events, while vasa vasorum and the macrophage density are associated with a thin fibrous cap and large necrotic core as well as increased serum levels of inflammatory biomarkers. One current challenge of OCT examinations is to detect morphologic characteristics capable of discriminating vulnerable from stable plaques. The ability to detect vulnerable plaques in vivo would allow physicians to identify patients at high risk for adverse coronary events, thus significantly helping to prevent ACS.
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Affiliation(s)
- Takashi Kubo
- Department of Cardiovascular Medicine, Wakayama Medical University
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Affiliation(s)
- Takashi Kubo
- Department of Cardiovascular Medicine, Wakayama Medical University
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35
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Ueda Y, Matsuo K, Nishimoto Y, Sugihara R, Nishio M, Hirata A, Asai M, Nemoto T, Murakami A, Kashiwase K, Tsujimoto M, Muller JE, Kodama K. Detection of yellow plaque by near-infrared spectroscopy - Comparison with coronary angioscopy in a case of no-flow phenomenon during coronary intervention. J Cardiol Cases 2014; 9:192-195. [PMID: 30534323 DOI: 10.1016/j.jccase.2014.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 11/19/2013] [Accepted: 01/16/2014] [Indexed: 10/25/2022] Open
Abstract
Yellow plaques detected by coronary angioscopy have been regarded as vulnerable plaques and associated with distal embolization or slow/no-flow phenomenon during coronary intervention. This is the first report that compared the findings of angioscopy and near-infrared spectroscopy (NIRS) in a patient who suffered no-flow phenomenon during coronary intervention. A 41-year-old male patient with silent myocardial ischemia received coronary intervention. Coronary angiogram revealed diffuse stenosis in the distal right coronary artery. Target lesion was examined by NIRS and angioscopy. NIRS can detect lipid core plaque, which is presented as an yellow area in contrast to the normal red area. Target segment was filled with lipid core plaques. On the other hand, angioscopy revealed a ruptured yellow plaque with a thrombus in the target segment. The distribution of yellow plaques detected by angioscopy appeared well corresponded to the yellow areas detected by NIRS. After the insertion of filter-type distal protection device, balloon pre-dilatation and stent implantation were performed. Then, no-flow phenomenon occurred. Coronary flow was finally recovered in the protected vessel but was still disturbed in the non-protected vessel. The filter was filled with much plaque debris. The correlation between the yellow area detected by NIRS and the yellow plaques detected by angioscopy appeared very well. <Learning objective: The correlation between the yellow area detected by near-infrared spectroscopy (NIRS) and the yellow plaques detected by angioscopy appeared very well. As well as yellow plaque detected by angioscopy, lipid core plaque as shown in yellow area by NIRS may also be associated with future event of acute coronary syndrome and distal embolization during coronary intervention.>.
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Affiliation(s)
- Yasunori Ueda
- Cardiovascular Division, Osaka Police Hospital, Osaka, Japan
| | - Koshi Matsuo
- Cardiovascular Division, Osaka Police Hospital, Osaka, Japan
| | - Yuji Nishimoto
- Cardiovascular Division, Osaka Police Hospital, Osaka, Japan
| | - Ryuta Sugihara
- Cardiovascular Division, Osaka Police Hospital, Osaka, Japan
| | - Mayu Nishio
- Cardiovascular Division, Osaka Police Hospital, Osaka, Japan
| | - Akio Hirata
- Cardiovascular Division, Osaka Police Hospital, Osaka, Japan
| | - Mitsutoshi Asai
- Cardiovascular Division, Osaka Police Hospital, Osaka, Japan
| | | | - Ayaka Murakami
- Cardiovascular Division, Osaka Police Hospital, Osaka, Japan
| | | | | | | | - Kazuhisa Kodama
- Cardiovascular Division, Osaka Police Hospital, Osaka, Japan
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36
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Takayama T, Hiro T, Ueda Y, Saito S, Kodama K, Komatsu S, Hirayama A. Remodeling pattern is related to the degree of coronary plaque regression induced by pitavastatin: a sub-analysis of the TOGETHAR trial with intravascular ultrasound and coronary angioscopy. Heart Vessels 2014; 30:169-76. [PMID: 24463843 DOI: 10.1007/s00380-014-0468-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 01/10/2014] [Indexed: 12/26/2022]
Abstract
This study aimed to clarify the relationships between arterial remodeling patterns and plaque volume regression or stabilization. The TOGETHAR trial is a prospective open-label trial designed to assess coronary plaque regression and stabilization with multiple plaque imaging modalities following 52 weeks of pitavastatin treatment (2 mg/day). Coronary plaques were observed in 46 patients with both angioscopy and intravascular ultrasound at baseline and after 52 weeks of drug treatment. We divided these patients into three groups according to their remodeling indices (RI). Group P consisted of patients with a baseline RI >1.05, Group M of patients with a baseline RI of 0.95-1.05, and Group N of patients with a baseline RI <0.95 and then evaluated differences in coronary plaque volume changes and yellow grade among the three groups. In the positive remodeling group, whose remodeling index (RI) exceeded 1.05 at baseline, RI and percent atheroma volume (PAV) were significantly reduced (RI 1.14 ± 0.07 to 1.05 ± 0.10, p = 0.010, PAV 47.3 ± 8.3 to 45.3 ± 7.3 mm(3), p = 0.048). There was no relationship between baseline RI and the change in yellow grade of plaque. RI increased without significant change of PAV or a decrease in lumen volume in group N, with RI below 0.95 at baseline. Plaques with positive remodeling were more likely to have plaque volume regression by pitavastatin than those without in patients with coronary artery disease. Moreover, plaques with positive and negative remodeling were changed into those with intermediate remodeling by pitavastatin. Pitavastatin might induce not only plaque regression or stabilization, but also conformational normalization of vessel structure.
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Affiliation(s)
- Tadateru Takayama
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan,
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Kubo T, Akasaka T. Recent advances in intracoronary imaging techniques: focus on optical coherence tomography. Expert Rev Med Devices 2014; 5:691-7. [DOI: 10.1586/17434440.5.6.691] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Takashi Kubo
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama, 641-8509, Japan
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama, 641-8509, Japan
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Longitudinal extent of lipid pool assessed by optical coherence tomography predicts microvascular no-reflow after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. J Cardiol 2013; 62:71-6. [DOI: 10.1016/j.jjcc.2013.03.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 02/15/2013] [Accepted: 03/18/2013] [Indexed: 11/20/2022]
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Magro M, Regar E, Gutiérrez-Chico JL, Garcia-Garcia H, Simsek C, Schultz C, Zijlstra F, Serruys PW, van Geuns RJ. Residual atherothrombotic material after stenting in acute myocardial infarction — An optical coherence tomographic evaluation. Int J Cardiol 2013; 167:656-63. [DOI: 10.1016/j.ijcard.2012.03.073] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2011] [Revised: 01/17/2012] [Accepted: 03/03/2012] [Indexed: 10/28/2022]
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Plaque stabilization by intensive LDL-cholesterol lowering therapy with atorvastatin is delayed in type 2 diabetic patients with coronary artery disease—Serial angioscopic and intravascular ultrasound analysis. J Cardiol 2013; 61:381-6. [DOI: 10.1016/j.jjcc.2013.01.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 11/29/2012] [Accepted: 01/21/2013] [Indexed: 11/16/2022]
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Matsuo K, Ueda Y, Nishio M, Hirata A, Asai M, Nemoto T, Murakami A, Kashiwase K, Kodama K. A higher colour grade yellow plaque was detected at one year after implantation of an everolimus-eluting stent than after a zotarolimus-eluting stent. HEART ASIA 2013; 5:192-6. [PMID: 27326125 DOI: 10.1136/heartasia-2013-010378] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 08/05/2013] [Accepted: 08/25/2013] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Neoatherosclerosis or atherosclerosis progression is one of the mechanisms of long-term stent failure. Yellow plaque detected by angioscopy has been associated with advanced atherosclerosis and the future risk of a coronary event. We compared the yellow colour of the stented segment between zotarolimus-eluting stents (ZES) and everolimus-eluting stents (EES) at 1 year after implantation. DESIGN Cross-sectional study. PATIENTS Consecutive patients underwent angioscopic examination 1 year after the implantation of ZES (n=45) or EES (n=45) at a de novo native coronary lesion. MAIN OUTCOME MEASURES The maximum yellow colour grade (grade 0-3) of the stented segment, maximum and minimum neointima coverage grade (grade 0-2) and the presence of thrombus were examined. The neointima heterogeneity index was calculated as maximum - minimum coverage grade. RESULTS Maximum yellow colour grade was higher in EES than in ZES (1.3±0.9 vs 0.4±0.8, p<0.001) and maximum (2.0±0.2 vs 1.2±0.5, p<0.001) and minimum (1.5±0.6 vs 0.7±0.5, p<0.001) coverage grade was higher in ZES than in EES. The neointima heterogeneity index was not different between ZES and EES (0.4±0.5 vs 0.5±0.6, p=0.42). The incidence of thrombus was very low and was not different between ZES and EES (2% vs 4%, p=0.55). CONCLUSIONS Although both ZES and EES had good healing with homogeneous neointima coverage and a low incidence of thrombus, EES had more advanced atherosclerosis as shown by the presence of higher grade yellow plaque than ZES at 1 year after implantation.
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Affiliation(s)
- Koshi Matsuo
- Cardiovascular Division , Osaka Police Hospital , Osaka , Japan
| | - Yasunori Ueda
- Cardiovascular Division , Osaka Police Hospital , Osaka , Japan
| | - Mayu Nishio
- Cardiovascular Division , Osaka Police Hospital , Osaka , Japan
| | - Akio Hirata
- Cardiovascular Division , Osaka Police Hospital , Osaka , Japan
| | - Mitsutoshi Asai
- Cardiovascular Division , Osaka Police Hospital , Osaka , Japan
| | | | - Ayaka Murakami
- Cardiovascular Division , Osaka Police Hospital , Osaka , Japan
| | | | - Kazuhisa Kodama
- Cardiovascular Division , Osaka Police Hospital , Osaka , Japan
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42
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Wada M, Ueda Y, Higo T, Matsuo K, Nishio M, Hirata A, Asai M, Nemoto T, Kashiyama T, Murakami A, Kashiwase K, Kodama K. Chronic kidney disease and coronary artery vulnerable plaques. Clin J Am Soc Nephrol 2012; 6:2792-8. [PMID: 22157709 DOI: 10.2215/cjn.06780711] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Chronic kidney disease (CKD) is a risk factor of cardiovascular disease. The number of yellow plaques is a predictor of future cardiovascular events. We assumed that CKD might raise the risk of cardiovascular events by increasing the number of yellow plaques. Therefore, we compared the number of yellow plaques between patients with and without CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Consecutive 136 patients with acute myocardial infarction who received percutaneous coronary intervention (PCI) and angioscopic examination were analyzed. The infarct-related artery was angioscopically examined. The number of yellow plaques, maximum yellow color grade of detected yellow plaques, and prevalence of disrupted yellow plaques in nonculprit segments were compared between patients with and without CKD. RESULTS The number of yellow plaques was significantly larger in CKD than in non-CKD patients (median [interquartile range]: 4.0 [2.0 to 6.0] versus 2.0 [1.0 to 4.0], P = 0.001). Maximum yellow color grade and prevalence of disrupted plaques in the nonculprit segments were not different between patients with and without CKD. Multivariate logistic regression analysis revealed CKD as an independent risk of multiple yellow plaques per vessel (odds ratio 3.49, 95% confidence interval 1.10 to 11.10, P = 0.03). CONCLUSION CKD was an independent risk factor of multiple coronary yellow plaques, suggesting that patients with CKD would have a higher risk of coronary events because they had more yellow plaques than patients without CKD.
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Affiliation(s)
- Mitsuru Wada
- Cardiovascular Division, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-ku, Osaka, 543-0035 Japan
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43
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Miyamoto Y, Okura H, Kume T, Kawamoto T, Neishi Y, Hayashida A, Yamada R, Imai K, Saito K, Yoshida K. Plaque characteristics of thin-cap fibroatheroma evaluated by OCT and IVUS. JACC Cardiovasc Imaging 2012; 4:638-46. [PMID: 21679899 DOI: 10.1016/j.jcmg.2011.03.014] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2010] [Revised: 03/02/2011] [Accepted: 03/10/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The purpose of this study was to assess plaque characteristics of optical coherence tomography (OCT)-derived thin-cap fibroatheroma (TCFA) by integrated backscatter intravascular ultrasound (IB-IVUS). BACKGROUND Radiofrequency signal-derived IVUS tissue characterization technology has become clinically available and provided objective and quantitative plaque characteristics of the coronary vessel wall. Integrated backscatter IVUS is one of the tissue characterization methods that can possibly provide quantitative plaque characteristics of the OCT-derived TCFA. METHODS Eighty-one coronary lesions with plaque burden >40% were selected and analyzed with both IB-IVUS and OCT. The OCT-derived TCFA was defined as a presence of thin fibrous cap (<65 μm) overlying a signal-poor lesion with diffuse border representing a lipid-rich plaque. By conventional gray-scale IVUS, external elastic membrane (EEM) cross-sectional area (CSA), lumen CSA, plaque plus media (P+M) CSA, plaque burden and remodeling index were measured. By IB-IVUS, plaque characteristics were further classified as fibrosis, dense fibrosis, calcification, or lipid pool. RESULTS Optical coherence tomography identified 40 TCFAs (49%) and 41 non-TCFAs. The EEM CSA, P+M CSA, plaque burden, and remodeling index were significantly larger in OCT-derived TCFA than non-TCFA. By IB-IVUS, percentage lipid pool area (= lipid pool area/P+M CSA × 100) was significantly higher (62.4 ± 12.8% vs. 38.4 ± 13.1%, p<0.0001) and percentage fibrosis area (= fibrosis area/P+M CSA × 100) was significantly lower (34.6 ± 11.4% vs. 50.5 ± 8.7%, p<0.0001) in OCT-derived TCFA than non-TCFA. By receiver-operator characteristic curve analysis, percentage lipid pool area ≥55%, percentage fibrosis area ≤41%, and remodeling index ≥1.0 were predictors of OCT-derived TCFA. CONCLUSIONS The OCT-derived TCFA had larger plaque burden and positive remodeling with predominant lipid component and less fibrous plaque assessed by IB-IVUS.
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Affiliation(s)
- Ik-Kyung Jang
- From Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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45
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Madder RD, Smith JL, Dixon SR, Goldstein JA. Composition of Target Lesions by Near-Infrared Spectroscopy in Patients With Acute Coronary Syndrome Versus Stable Angina. Circ Cardiovasc Interv 2012; 5:55-61. [DOI: 10.1161/circinterventions.111.963934] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Whereas acute coronary syndromes (ACS) typically develop from the rupture of lipid core plaque (LCP), lesions causing stable angina are believed to be composed of fibrocalcific plaque. In this study, intracoronary near-infrared spectroscopy (NIRS) was used to determine the frequency of LCP at target and remote sites in patients with ACS versus those with stable angina.
Methods and Results—
The study was performed in patients having ≥1 target lesion identified by invasive angiography who also underwent NIRS before intervention. LCP was defined as a 2-mm segment on the NIRS block chemogram having a strong positive reading indicated by a bright-yellow color. Patients with ACS and those with stable angina were compared for the frequency of LCP at target and remote sites. Among 60 patients (46.7% with ACS) undergoing invasive angiography and NIRS, 68 target lesions were identified. Although target lesions in patients with ACS were more frequently composed of LCP than targets in patients with stable angina (84.4% versus 52.8%,
P
=0.004), approximately one half of target lesions in patients with stable angina contained LCP. LCPs anatomically remote from the target lesion were frequent in patients with ACS and less common in patients with stable angina (73.3% versus 17.6%,
P
=0.002).
Conclusions—
Target lesions responsible for ACS were frequently composed of LCP; in addition, LCPs often were found in remote, nontarget areas. Both target and remote LCPs were more common in patients with ACS than in those with stable angina. Approximately one half of target lesions in stable patients were also composed of LCP.
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Affiliation(s)
- Ryan D. Madder
- From the Frederik Meijer Heart and Vascular Institute, Spectrum Health System, Grand Rapids, MI (R.D.M.), and Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI (J.L.S., S.R.D., J.A.G.)
| | - James L. Smith
- From the Frederik Meijer Heart and Vascular Institute, Spectrum Health System, Grand Rapids, MI (R.D.M.), and Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI (J.L.S., S.R.D., J.A.G.)
| | - Simon R. Dixon
- From the Frederik Meijer Heart and Vascular Institute, Spectrum Health System, Grand Rapids, MI (R.D.M.), and Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI (J.L.S., S.R.D., J.A.G.)
| | - James A. Goldstein
- From the Frederik Meijer Heart and Vascular Institute, Spectrum Health System, Grand Rapids, MI (R.D.M.), and Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI (J.L.S., S.R.D., J.A.G.)
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Okada K, Ueda Y, Takayama T, Honye J, Komatsu S, Yamaguchi O, Li Y, Yajima J, Takazawa K, Nanto S, Saito S, Hirayama A, Kodama K. Influence of Achieved Low-Density Lipoprotein Cholesterol Level With Atorvastatin Therapy on Stabilization of Coronary Plaques. Circ J 2012; 76:1197-202. [DOI: 10.1253/circj.cj-11-0966] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | - Tadateru Takayama
- Division of Cardiology, Department of Medicine, Nihon University, School of Medicine
| | - Junko Honye
- Department of Cardiology, Fuchu Keijin-kai Hospital
| | - Sei Komatsu
- Cardiovascular Division, Amagasaki Central Hospital
| | - Osamu Yamaguchi
- Department of Cardiovascular Medicine, Osaka University, Graduate School of Medicine
| | - Yuxin Li
- Department of Advanced Cardiovascular Imaging, Nihon University School of Medicine
| | - Junji Yajima
- Department of Cardiology, The Cardiovascular Institute Hospital
| | - Kenji Takazawa
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center
| | - Shinsuke Nanto
- Department of Advanced Cardiovascular Therapeutics, Osaka University, Graduate School of Medicine
| | - Satoshi Saito
- Division of Cardiology, Department of Medicine, Nihon University, School of Medicine
| | - Atsushi Hirayama
- Division of Cardiology, Department of Medicine, Nihon University, School of Medicine
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Li X, Villard JW, Ouyang Y, Michalek JE, Jabara R, Sims D, Kemp N, Glynn T, Banas C, Bailey SR, Feldman MD. Safety and efficacy of frequency domain optical coherence tomography in pigs. EUROINTERVENTION 2011; 7:497-504. [PMID: 21764669 DOI: 10.4244/eijv7i4a80] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS To determine the safety and efficacy of frequency domain OCT, which can scan at much higher rates and make it possible to avoid an occlusion balloon and image during an angiographic injection through guide catheter. The catheters have diameters ranging from 2.7 to 3.5 Fr. The presence of the imaging catheter increases fluid resistance to the injection of viscous solutions necessary for clearing the blood. METHODS AND RESULTS The Volcano 3.5 Fr frequency domain OCT catheter system was investigated for safety in (a) n=10 porcine studies using acute and 30-day histology, and (b) for efficacy in n=9 in vivo porcine coronary arteries. We found: (a) frequency domain imaging is safe in the porcine model using histology as an endpoint; (b) the addition of a viscous contrast (iodixonal) to saline is superior for lumen clearance compared to saline alone; (c) hand injection, 4 ml/sec, and 6 ml/sec power injection all provided similar vessel wall clearance; (d) the anticipated loss of vessel wall visualisation with left main injection (due to half the injectate in the non-imaged vessel) was not evident in proximal and middle coronary artery OCT catheter positions. CONCLUSIONS Frequency domain OCT is safe and efficacious in the porcine model.
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Affiliation(s)
- Xiankai Li
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
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Cicha I, Wörner A, Urschel K, Beronov K, Goppelt-Struebe M, Verhoeven E, Daniel WG, Garlichs CD. Carotid plaque vulnerability: a positive feedback between hemodynamic and biochemical mechanisms. Stroke 2011; 42:3502-10. [PMID: 21998063 DOI: 10.1161/strokeaha.111.627265] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Rupture of atherosclerotic plaques is one of the main causes of ischemic strokes. The aim of this study was to investigate carotid plaque vulnerability markers in relation to blood flow direction and the mechanisms leading to plaque rupture at the upstream side of carotid stenoses. METHODS Frequency and location of rupture, endothelial erosion, neovascularization, and hemorrhage were determined in longitudinal sections of 80 human carotid specimens. Plaques were immunohistochemically analyzed for markers of vulnerability. Plaque geometry was measured to reconstruct shape profiles of ruptured versus stable plaques and to perform computational fluid dynamics analyses. RESULTS In 86% of ruptured plaques, rupture was observed upstream. In this region, neovascularization and hemorrhage were increased, along with increased immunoreactivity of vascular endothelial and connective tissue growth factor, whereas endothelial erosion was more frequent downstream. Proteolytic enzymes, mast cell chymase and cathepsin L, and the proapoptotic protein Bax showed significantly higher expression upstream as compared with the downstream shoulder of atherosclerotic lesions. Comparison of geometric profiles for ruptured and stable plaques showed increased longitudinal asymmetry of fibrous cap and lipid core thickness in ruptured plaques. The specific geometry of plaques ruptured upstream induced increased levels of shear stress and increased pressure drop between the upstream and the downstream plaque shoulders. CONCLUSIONS Vulnerability of the upstream plaque region is associated with enhanced neovascularization, hemorrhage, and cap thinning induced by proteolytic and proapoptotic mechanisms. These processes are reflected in structural plaque characteristics, analyses of which could improve the efficacy of vascular diagnostics and prevention.
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Affiliation(s)
- Iwona Cicha
- Laboratory of Molecular Cardiology, Department of Cardiology and Angiology, University of Erlangen-Nuremberg, Schwabachanlage 10, 91054 Erlangen, Germany.
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Ueda Y, Matsuo K, Nishio M, Hirata A, Nemoto T, Asai M, Murakami A, Kashiwase K, Kodama K. Systemic and local factors associated with coronary plaque disruption. Thromb Res 2011; 129:164-8. [PMID: 21975031 DOI: 10.1016/j.thromres.2011.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Revised: 09/01/2011] [Accepted: 09/12/2011] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Yellow plaques are regarded vulnerable; and disrupted yellow plaques are the major cause of acute coronary syndrome. We examined the factors associated with the disruption of yellow plaques among patients and lesion characteristics. MATERIALS AND METHODS Consecutive 161 patients with ischemic heart diseases who received coronary angioscopic examination were analyzed. Yellow plaques in the segments to which intervention had never been performed were included, and their yellow color grade and presence/ absence of disruption were examined. Associated factors for plaque disruption were examined among patients and lesion characteristics. RESULTS In 161 patients, 392 yellow plaques were included for analysis and 70 of them were disrupted. Frequency of plaque disruption (=disrupted / all yellow plaques) was significantly higher at the segments of severer stenosis (stenosis≥75% vs. 75-25% vs. <25%: 34% vs. 21% vs. 14%, p=0.006). Multivariate analysis revealed angiographic stenosis (odds ratio [OR], 1.014; 95% confidence interval [CI], 1.005-1.023; p=0.003), yellow color grade (OR, 3.297; 95% CI, 2.062-5.273, p<0.001), LDL-cholesterol (OR, 1.012; 95% CI, 1.004-1.020, p=0.003), male gender (OR, 3.608; 95% CI, 1.538-8.465; p=0.003), and hypertension (OR, 2.552; 95% CI, 1.094-5.953; p=0.030) as significant associated factors for plaque disruption. CONCLUSION Angiographic stenosis, yellow color grade, LDL-cholesterol, male gender, and hypertension were significantly associated with the disruption of yellow plaques.
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Affiliation(s)
- Yasunori Ueda
- Cardiovascular Division, Osaka Police Hospital, Osaka, Japan.
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Kubo T, Ino Y, Tanimoto T, Kitabata H, Tanaka A, Akasaka T. Optical coherence tomography imaging in acute coronary syndromes. Cardiol Res Pract 2011; 2011:312978. [PMID: 21941666 PMCID: PMC3177459 DOI: 10.4061/2011/312978] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Accepted: 07/25/2011] [Indexed: 12/03/2022] Open
Abstract
Optical coherence tomography (OCT) is a high-resolution imaging technique that offers microscopic visualization of coronary plaques. The clear and detailed images of OCT generate an intense interest in adopting this technique for both clinical and research purposes. Recent studies have shown that OCT is useful for the assessment of coronary atherosclerotic plaques, in particular the assessment of plaque rupture, erosion, and intracoronary thrombus in patients with acute coronary syndrome. In addition, OCT may enable identifying thin-cap fibroatheroma, the proliferation of vasa vasorum, and the distribution of macrophages surrounding vulnerable plaques. With its ability to view atherosclerotic lesions in vivo with such high resolution, OCT provides cardiologists with the tool they need to better understand the thrombosis-prone vulnerable plaques and acute coronary syndromes. This paper reviews the possibility of OCT for identification of vulnerable plaques in vivo.
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Affiliation(s)
- Takashi Kubo
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8510, Japan
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