A virtual histology intravascular ultrasound analysis of coronary chronic total occlusions. Issue 3 (29th March 2012)

• Record Type: Journal Article
• Authors: Guo, Jun; Maehara, Akiko; Mintz, Gary S; Ashida, Kazuhiro; Pu, Jun; Shang, Yunpeng; Leon, Martin B.; Stone, Gregg W.; Moses, Jeffrey W.; Ochiai, Masahiko
• Is Part Of: Catheterization and cardiovascular interventions. Volume 81:Issue 3(2013:Feb. 15)
• Page Start: 464
• Page End: 470
• Publication Date: 2012-03-29
• Subjects: Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.24356
• Languages: English
• ISSNs: 1522-1946

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="ccd24356-sec-0001" sec-type="section"> <title>Objectives</title> <p>We used virtual histology intravascular ultrasound (VH‐IVUS) to investigate plaque composition of chronic total occlusions (CTO).</p> </sec> <sec id="ccd24356-sec-0002" sec-type="section"> <title>Background</title> <p>There are limited data on the composition of CTOs, especially <italic>in vivo</italic>.</p> </sec> <sec id="ccd24356-sec-0003" sec-type="section"> <title>Methods</title> <p>VH‐IVUS was performed in 50 CTO lesions (49 patients) after guidewire crossing or pre‐dilation using a 1.5–2 mm balloon. Plaque composition in the proximal reference, distal reference, and CTO segment (subsequently divided into proximal, middle, and distal subsegments) was analyzed and reported as median and interquartile range. VH‐IVUS phenotype was also assessed. The definition of a fibroatheroma was >10% confluent necrotic core (NC) in more than three consecutive frames.</p> </sec> <sec id="ccd24356-sec-0004" sec-type="section"> <title>Results</title> <p>Overall, the maximum NC within the CTO [35.5% (28.7, 44.3%)] was similar to the proximal reference [35.6% (24.1, 42.1%)] and greater than the distal reference [31.5% (22.6, 35.2%), <italic>P</italic> < 0.01]. There was no difference in maximum NC observed among proximal [31.4% (25.2, 10.4%)], middle [31.0% (23.3, 38.3%)], and distal CTO subsegments [30.4% (22.0, 39.5%)]. Overall, 42/50 CTOs contained a VH‐fibroathroma; and 8/50 did not. CTOs containing a VH‐fibroatheroma had more NC and dense calcium while CTOs not containing a fibroatheroma had more fibrotic and fibrofatty plaque. Importantly, 60.5% of VH‐fibroatheroma‐containing CTOs had a thin‐cap fibroatheroma (NC abutted to the lumen) in the proximal reference.</p> </sec> <sec id="ccd24356-sec-0005" sec-type="section"> <title>Conclusions</title> <p>Using VH‐IVUS, CTO morphology can be divided into two patterns: (1) CTO with VH‐fibroatheroma or (2) CTO without VH‐fibroatheroma. This suggests two mechanisms of CTO formation—the majority evolving from acute coronary syndrome and thrombosis and the minority from atherosclerosis progression. © 2012 Wiley Periodicals, Inc.</p> </sec> </abstract>