1
|
Liu X, Sun C, Tian J, Liu X, Fang S, Xi X, Gu X, Sun Y, Tian J, Yu B. Shrinkage as a potential mechanism of recurrent clinical events in patients with a large vulnerable plaque. J Cardiovasc Med (Hagerstown) 2019; 20:518-524. [PMID: 30889077 DOI: 10.2459/jcm.0000000000000783] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS This study aimed to investigate the progression and vascular shrinkage of vulnerable plaque lesions with a plaque burden at least 70% among patients with coronary artery disease by optical coherence tomography (OCT) and intravascular ultrasound (IVUS). METHODS Fifty-six OCT-identified vulnerable plaques from 47 patients were included among coronary angiography-identified nonculprit/nontarget lesions. Serial IVUS images were used to assess plaque progression and vascular shrinkage. RESULTS Thirty-five small vulnerable plaques (plaque burden <70%, group A) and 21 large vulnerable plaques (plaque burden ≥70%, group B) were identified. The IVUS results at baseline show that mean plaque areas (P < 0.001) and the percentage atheroma volume (PAV) (P < 0.0001) were greater and the minimal lumen area (P < 0.0001) was smaller in group B. The absolute and relative changes in the PAV and mean plaque area from baseline to follow-up were not significantly different. However, the lesions exhibited vessel shrinkage [the mean external elastic membrane (EEM) area (P = 0.02) and mean lumen area (P = 0.03) were significantly smaller in group B] from baseline to follow-up. Patients in group B also exhibited clinical events (recurrent angina symptoms) during the follow-up period. Positive correlations were found between changes in the mean plaque area and the mean EEM area in large vulnerable plaques (r = 0.61, P < 0.0001) and between changes in the mean EEM area and the mean lumen area in large vulnerable plaques (r = 0.61, P < 0.0001). CONCLUSION Vulnerable plaque progression was not different between small and large vulnerable plaques. However, large vulnerable plaque lesions tended to exhibit vascular shrinkage, which is possible a cause of coronary artery lumen loss in patients with large vulnerable plaques.
Collapse
Affiliation(s)
- Xianglan Liu
- Department of Cardiology, the Second Affiliated Hospital of Harbin Medical University, Harbin.,The Key Laboratory of Myocardial Ischemia, Harbin Medical University, Ministry of Education, Heilongjiang Province
| | - Changbin Sun
- Department of Cardiology, the Second Affiliated Hospital of Harbin Medical University, Harbin.,The Key Laboratory of Myocardial Ischemia, Harbin Medical University, Ministry of Education, Heilongjiang Province
| | - Jiangtian Tian
- Department of Cardiology, the Second Affiliated Hospital of Harbin Medical University, Harbin.,The Key Laboratory of Myocardial Ischemia, Harbin Medical University, Ministry of Education, Heilongjiang Province
| | - Xinxin Liu
- Department of Cardiology, the Second Affiliated Hospital of Harbin Medical University, Harbin.,The Key Laboratory of Myocardial Ischemia, Harbin Medical University, Ministry of Education, Heilongjiang Province
| | - Shaohong Fang
- Department of Cardiology, the Second Affiliated Hospital of Harbin Medical University, Harbin.,The Key Laboratory of Myocardial Ischemia, Harbin Medical University, Ministry of Education, Heilongjiang Province
| | - Xiangwen Xi
- Department of Cardiology, the Second Affiliated Hospital of Harbin Medical University, Harbin.,The Key Laboratory of Myocardial Ischemia, Harbin Medical University, Ministry of Education, Heilongjiang Province
| | - Xia Gu
- The Key Laboratory of Myocardial Ischemia, Harbin Medical University, Ministry of Education, Heilongjiang Province.,Department of Cardiology, the Heilongjiang Provincial Hospital, Harbin, China
| | - Yong Sun
- Department of Cardiology, the Second Affiliated Hospital of Harbin Medical University, Harbin.,The Key Laboratory of Myocardial Ischemia, Harbin Medical University, Ministry of Education, Heilongjiang Province
| | - Jinwei Tian
- Department of Cardiology, the Second Affiliated Hospital of Harbin Medical University, Harbin.,The Key Laboratory of Myocardial Ischemia, Harbin Medical University, Ministry of Education, Heilongjiang Province
| | - Bo Yu
- Department of Cardiology, the Second Affiliated Hospital of Harbin Medical University, Harbin.,The Key Laboratory of Myocardial Ischemia, Harbin Medical University, Ministry of Education, Heilongjiang Province
| |
Collapse
|
2
|
Kawamoto R, Hatakeyama K, Imamura T, Ishikawa T, Date H, Shibata Y, Takenaga M, Asada Y, Eto T. Relation of C-reactive protein to restenosis after coronary stent implantation and to restenosis after coronary atherectomy. Am J Cardiol 2004; 94:104-7. [PMID: 15219517 DOI: 10.1016/j.amjcard.2004.03.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2003] [Revised: 03/15/2004] [Accepted: 03/15/2004] [Indexed: 11/20/2022]
Abstract
To determine whether the inflammatory response is equally involved in the pathogenesis of restenosis after coronary stenting and directional coronary atherectomy, we assessed restenotic lesions with immunohistochemical methods. Levels of C-reactive protein and macrophages were greater in patients with in-stent restenosis than in those with restenosis after directional coronary atherectomy. This suggests that the inflammatory response is more involved in the pathogenesis of in-stent restenosis than in restenosis after directional coronary atherectomy.
Collapse
Affiliation(s)
- Riichirou Kawamoto
- First Department of Internal Medicine, Miyazaki Medical College, Miyazaki, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Kawamura A, Asakura Y, Okabe T, Yamane A, Hui-Chong L, Ogawa S. Predictors of vessel remodeling following directional coronary atherectomy. Catheter Cardiovasc Interv 2003; 61:44-51. [PMID: 14696158 DOI: 10.1002/ccd.10737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The purpose of this study was to clarify predictors of vessel remodeling following directional coronary atherectomy (DCA). Negative remodeling after DCA leads to restenosis. However, little is known about the predictors of the vessel remodeling. Serial IVUS was performed in 43 lesions. The vessel remodeling was defined as adaptive if vessel area at follow-up minus postprocedure vessel area was > 0 mm2, or as constrictive if < 0 mm2. Adaptive remodeling occurred in 21 (49%) lesions. Postprocedure percent plaque area was smaller in the adaptive group (32.9% +/- 5.7% vs. 45.5% +/- 8.8%; P < 0.005). At follow-up, vessel area was larger in the adaptive group. However, plaque area was similar between the two groups. As a result, lumen area was larger in the adaptive group. Multivariate analyses showed that postprocedure percent plaque area < 40% was the only predictor of adaptive remodeling (odds ratio, 6.68; P < 0.05).
Collapse
Affiliation(s)
- Akio Kawamura
- Cardiopulmonary Division, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
| | | | | | | | | | | |
Collapse
|