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Association between internal running vasa vasorum in optical coherence tomography and slow flow during percutaneous coronary intervention
Background: Coronary intraplaque vasa vasorum is associated with plaque vulnerability and plaque progression. Especially, the internal longitudinal running vasa vasorum have high plaque vulnerability. Optical coherence tomography (OCT) have high resolution. Therefore, OCT enables detect the internal longitudinal running vasa vasorum. Thin-cap fibroatheroma (TCFA) and lipid-rich plaque in OCT are associated with slow flow during percutaneous coronary intervention (PCI). However, plaque vulnerability and incidence of slow flow during PCI of the internal longitudinal running vasa vasorum is unclear. Using OCT, we investigated plaque vulnerability and incidence of slow flow during PCI of the internal longitudinal running vasa vasorum.
Method: Subjects were 71 lesions undergoing OCT before PCI between February 2012 and July 2016. Internal running vasa vasorum was defined as intraplaque neovessels running from the adventitia to plaque. Lesions with internal running vasa vasorum were found in 47% (33/71).
Results: Compared to lesions without internal running vasa vasorum, lesions with internal running vasa vasorum showed significantly higher incidence of intimal laceration (64% [21/33] vs. 16% [6/38], p<0.001), lipid-rich plaque (79% [26/33] vs. 26% [10/38], p<0.001), plaque rupture (52% [17/33] vs. 13% [5/38], p<0.001), thin-cap fibroatheroma (TCFA) (58% [19/33] vs. 11% [4/38], p<0.001), macrophage accumulation (61% [20/33]vs. 26% [10/38], p=0.004), intraluminal thrombus (36% [12/33] vs. 3% [1/38], p<0.001) and slow flow during after stent implantation (42% [14/33] vs. 13% [5/38], p=0.007). In lesions with internal running vasa vasorum, TIMI flow was significantly shifted from 3.0±0.0 before stenting to 2.6±0.5 after stenting (p<0.001). ΔTIMI flow was significantly higher in lesions with internal running vasa vasorum than lesions without internal running vasa vasorum (0.4±0.2 vs. 0.2±0.4, p=0.027). Number of internal running vasa vasorum in lesions with slow flow after stent implantation was significantly higher than lesions without slow flow after stent implantation (3.1±4.2 vs. 0.7±1.1, P<0.001). The multivariable analysis showed internal running vasa vasorum was an independent predictor of slow flow after stent implantation (odds ratio 4.23, 95% CI 1.05–17.01, p=0.042).
Conclusion: Lesions with internal running vasa vasorum in OCT had high plaque vulnerability with more intimal laceration, lipid-rich plaque, plaque rupture, TCFA, macrophage accumulation and intraluminal thrombus. Lesions with internal running vasa vasorum were strongly associated with slow flow after stent implantation.
ESC 365 is supported by Bayer, Boehringer Ingelheim and Lilly Alliance, Bristol-Myers Squibb and Pfizer Alliance, Novartis Pharma AG and Vifor Pharma in the form of educational grants. The sponsors were not involved in the development of this platform and had no influence on its content.
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