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VH-IVUS analysis of attenuated plaque and ulcerated plaque and the relation between the plaque composition and slow flow/no reflow phenomenon during PCI

Session Poster session 7

Speaker Hideo Amano

Event : ESC Congress 2014

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Coronary Artery Disease: Angiography, Invasive Imaging, FFR
  • Session type : Poster Session

Authors : H Amano (Tokyo,JP), T Yabe (Tokyo,JP), R Ohkubo (Tokyo,JP), M Toda (Tokyo,JP), J Yamazaki (Tokyo,JP), T Ikeda (Tokyo,JP)

H. Amano1 , T. Yabe1 , R. Ohkubo1 , M. Toda1 , J. Yamazaki1 , T. Ikeda1 , 1Toho University Faculty of Medicine, Department of Cardiovascular Medicine - Tokyo - Japan ,

European Heart Journal ( 2014 ) 35 ( Abstract Supplement ), 1148

Background: The attenuated and ulcerated plaques are thought as embolic prone plaque, however the plaque characteristics are unclear. This study aimed to assess the plaque characteristics of attenuated and ulcerated plaques in VH-IVUS and the incidence of slow flow/no reflow during PCI.

Methods: Subjects were 119 patients 121 lesions undergoing VH-IVUS before stenting. These lesions were divided into the 15 lesions with attenuated plaque, 24 lesions with ulcerated plaque, and 82 lesions without attenuated and ulcerated plaque (the control group).

Results: Results were shown in table. Of the ulceration group, the necrotic core area of acute coronary syndrome was significantly larger than the stable angina pectoris (3.0±1.4 mm2 vs. 1.8±1.0 mm2, p<0.05).

Conclusion: The attenuated plaque had significantly larger fibro-fatty tissue. The ulcerated plaque had significantly larger EEM CSA. The ulcerated plaque had significantly larger necrotic core and dense calcium. The ulcerated plaque in ACS had significantly larger necrotic core. The attenuated plaque and the ulcerated plaque showed higher frequency of slow flow/no reflow during PCI.

VH of Attenuation and Ulcerated plaque
Attenuation groupUlceration groupControl groupp value
Acute coronary syndrome9 (60%)14 (58%)42 (51%)n.s.
Reference vessel diameter (mm)3.07±0.583.41±0.583.15±0.51n.s.* <0.05**
 after stenting3 (20.0%)5 (20.8%)4 (4.9%)<0.05* <0.05**
Grayscale IVUS characteristics
 Lumen CSA (mm2)5.0±1.37.6±3.04.7±1.4n.s.* <0.01**
 EEM CSA (mm2)17.1±3.519.7±4.916.0±4.5n.s.* <0.01**
 Plaque and Media CSA (mm2)12.1±3.912.0±3.211.4±3.6n.s.* n.s.**
VH-IVUS characteristics
 Fibrous (%)55.7±9.556.9±10.061.7±9.9<0.05* <0.05**
 Fibro-fatty (%)27.5±9.510.4±5.813.9±8.2<0.01* <0.05**
 Necrotic core (%)12.2±6.120.7±9.015.9±9.0n.s.* <0.05**
 Dense calcium (%)4.6±3.012.3±6.48.3±7.1n.s.* <0.05**
 Fibrous (mm2)6.8±2.66.8±2.27.1±2.8n.s.* n.s.**
 Fibro-fatty (mm2)3.5±1.91.2±0.71.6±1.2<0.01* n.s.**
 Necrotic core (mm2)1.3±0.42.5±1.31.7±1.0n.s.* <0.01**
 Dense calcium (mm2)0.5±0.41.4±0.70.9±0.8n.s.* <0.01**

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