Coronary CT angiographic characteristics of culprit lesions in acute coronary syndromes not related to plaque rupture as defined by optical coherence tomography and angioscopy

Yukio Ozaki, Masanori Okumura, Tevfik F. Ismail, Sadako Motoyama, Hiroyuki Naruse, Kousuke Hattori, Hideki Kawai, Masayoshi Sarai, Yasushi Takagi, Junichi Ishii, Hirofumi Anno, Renu Virmani, Patrick W. Serruys, Jagat Narula

Research output: Contribution to journalArticle

74 Citations (Scopus)

Abstract

Aims Pathological and clinical optical coherence tomography (OCT) studies have indicated that acute coronary syndrome (ACS) lesions have either ruptured fibrous caps (RFC-ACS) or intact fibrous caps (IFC-ACS). Although computed tomographic (CT) angiographic characteristics of RFC-ACS include low-attenuation plaques and positive plaque remodelling, features associated with IFC-ACS have not been previously described. The aim of this study was to assess the CT characteristics of IFC-ACS lesions. Methods and resultsSeventy-four patients with ACS/stable angina consented to multimodality imaging, of which 66 underwent CT angiography. Of these, 57 culprit lesions in 57 patients were evaluated with sufficient image quality from all four of OCT, angioscopy, intravascular ultrasound, and CT angiography. Intraluminal thrombus was assessed by OCT/angioscopy, and culprit lesions further classified by OCT-based demonstration of fibrous cap integrity. Of 35 culprit lesions with ACS, OCT revealed IFC with thrombus in 10 (29) and RFC in the remaining 25 (71); all 22 lesions with stable angina had intact fibrous caps. Fibrous caps were significantly thinner in RFC-ACS than IFC-ACS and stable angina (45 ± 12, 131 ± 57, and 321 ± 146 μm, respectively; P 0.001). CT angiography revealed that low-attenuation plaques were more frequently observed in RFC-ACS than IFC-ACS and stable angina (88, 40, and 18; P 0.001) lesions. Similarly, positive remodelling was more predominantly seen in RFC-ACS than IFC-ACS and stable angina (96, 20, and 14; P 0.001). However, none of the specific CT angiography features clearly distinguished IFC-ACS from stable lesions. ConclusionIn contrast to the situation with RFC-ACS, distinct culprit lesion characteristics associated with non-rupture-related mechanisms are not identified by CT angiography. It will therefore not be possible to differentiate plaques likely to develop IFC-ACS from stable plaques.

Original languageEnglish
Pages (from-to)2814-2823
Number of pages10
JournalEuropean Heart Journal
Volume32
Issue number22
DOIs
Publication statusPublished - 01-11-2011

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Angioscopy
Optical Coherence Tomography
Acute Coronary Syndrome
Rupture
Stable Angina
Angiography
Thrombosis

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Ozaki, Yukio ; Okumura, Masanori ; Ismail, Tevfik F. ; Motoyama, Sadako ; Naruse, Hiroyuki ; Hattori, Kousuke ; Kawai, Hideki ; Sarai, Masayoshi ; Takagi, Yasushi ; Ishii, Junichi ; Anno, Hirofumi ; Virmani, Renu ; Serruys, Patrick W. ; Narula, Jagat. / Coronary CT angiographic characteristics of culprit lesions in acute coronary syndromes not related to plaque rupture as defined by optical coherence tomography and angioscopy. In: European Heart Journal. 2011 ; Vol. 32, No. 22. pp. 2814-2823.
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abstract = "Aims Pathological and clinical optical coherence tomography (OCT) studies have indicated that acute coronary syndrome (ACS) lesions have either ruptured fibrous caps (RFC-ACS) or intact fibrous caps (IFC-ACS). Although computed tomographic (CT) angiographic characteristics of RFC-ACS include low-attenuation plaques and positive plaque remodelling, features associated with IFC-ACS have not been previously described. The aim of this study was to assess the CT characteristics of IFC-ACS lesions. Methods and resultsSeventy-four patients with ACS/stable angina consented to multimodality imaging, of which 66 underwent CT angiography. Of these, 57 culprit lesions in 57 patients were evaluated with sufficient image quality from all four of OCT, angioscopy, intravascular ultrasound, and CT angiography. Intraluminal thrombus was assessed by OCT/angioscopy, and culprit lesions further classified by OCT-based demonstration of fibrous cap integrity. Of 35 culprit lesions with ACS, OCT revealed IFC with thrombus in 10 (29) and RFC in the remaining 25 (71); all 22 lesions with stable angina had intact fibrous caps. Fibrous caps were significantly thinner in RFC-ACS than IFC-ACS and stable angina (45 ± 12, 131 ± 57, and 321 ± 146 μm, respectively; P 0.001). CT angiography revealed that low-attenuation plaques were more frequently observed in RFC-ACS than IFC-ACS and stable angina (88, 40, and 18; P 0.001) lesions. Similarly, positive remodelling was more predominantly seen in RFC-ACS than IFC-ACS and stable angina (96, 20, and 14; P 0.001). However, none of the specific CT angiography features clearly distinguished IFC-ACS from stable lesions. ConclusionIn contrast to the situation with RFC-ACS, distinct culprit lesion characteristics associated with non-rupture-related mechanisms are not identified by CT angiography. It will therefore not be possible to differentiate plaques likely to develop IFC-ACS from stable plaques.",
author = "Yukio Ozaki and Masanori Okumura and Ismail, {Tevfik F.} and Sadako Motoyama and Hiroyuki Naruse and Kousuke Hattori and Hideki Kawai and Masayoshi Sarai and Yasushi Takagi and Junichi Ishii and Hirofumi Anno and Renu Virmani and Serruys, {Patrick W.} and Jagat Narula",
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Coronary CT angiographic characteristics of culprit lesions in acute coronary syndromes not related to plaque rupture as defined by optical coherence tomography and angioscopy. / Ozaki, Yukio; Okumura, Masanori; Ismail, Tevfik F.; Motoyama, Sadako; Naruse, Hiroyuki; Hattori, Kousuke; Kawai, Hideki; Sarai, Masayoshi; Takagi, Yasushi; Ishii, Junichi; Anno, Hirofumi; Virmani, Renu; Serruys, Patrick W.; Narula, Jagat.

In: European Heart Journal, Vol. 32, No. 22, 01.11.2011, p. 2814-2823.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Coronary CT angiographic characteristics of culprit lesions in acute coronary syndromes not related to plaque rupture as defined by optical coherence tomography and angioscopy

AU - Ozaki, Yukio

AU - Okumura, Masanori

AU - Ismail, Tevfik F.

AU - Motoyama, Sadako

AU - Naruse, Hiroyuki

AU - Hattori, Kousuke

AU - Kawai, Hideki

AU - Sarai, Masayoshi

AU - Takagi, Yasushi

AU - Ishii, Junichi

AU - Anno, Hirofumi

AU - Virmani, Renu

AU - Serruys, Patrick W.

AU - Narula, Jagat

PY - 2011/11/1

Y1 - 2011/11/1

N2 - Aims Pathological and clinical optical coherence tomography (OCT) studies have indicated that acute coronary syndrome (ACS) lesions have either ruptured fibrous caps (RFC-ACS) or intact fibrous caps (IFC-ACS). Although computed tomographic (CT) angiographic characteristics of RFC-ACS include low-attenuation plaques and positive plaque remodelling, features associated with IFC-ACS have not been previously described. The aim of this study was to assess the CT characteristics of IFC-ACS lesions. Methods and resultsSeventy-four patients with ACS/stable angina consented to multimodality imaging, of which 66 underwent CT angiography. Of these, 57 culprit lesions in 57 patients were evaluated with sufficient image quality from all four of OCT, angioscopy, intravascular ultrasound, and CT angiography. Intraluminal thrombus was assessed by OCT/angioscopy, and culprit lesions further classified by OCT-based demonstration of fibrous cap integrity. Of 35 culprit lesions with ACS, OCT revealed IFC with thrombus in 10 (29) and RFC in the remaining 25 (71); all 22 lesions with stable angina had intact fibrous caps. Fibrous caps were significantly thinner in RFC-ACS than IFC-ACS and stable angina (45 ± 12, 131 ± 57, and 321 ± 146 μm, respectively; P 0.001). CT angiography revealed that low-attenuation plaques were more frequently observed in RFC-ACS than IFC-ACS and stable angina (88, 40, and 18; P 0.001) lesions. Similarly, positive remodelling was more predominantly seen in RFC-ACS than IFC-ACS and stable angina (96, 20, and 14; P 0.001). However, none of the specific CT angiography features clearly distinguished IFC-ACS from stable lesions. ConclusionIn contrast to the situation with RFC-ACS, distinct culprit lesion characteristics associated with non-rupture-related mechanisms are not identified by CT angiography. It will therefore not be possible to differentiate plaques likely to develop IFC-ACS from stable plaques.

AB - Aims Pathological and clinical optical coherence tomography (OCT) studies have indicated that acute coronary syndrome (ACS) lesions have either ruptured fibrous caps (RFC-ACS) or intact fibrous caps (IFC-ACS). Although computed tomographic (CT) angiographic characteristics of RFC-ACS include low-attenuation plaques and positive plaque remodelling, features associated with IFC-ACS have not been previously described. The aim of this study was to assess the CT characteristics of IFC-ACS lesions. Methods and resultsSeventy-four patients with ACS/stable angina consented to multimodality imaging, of which 66 underwent CT angiography. Of these, 57 culprit lesions in 57 patients were evaluated with sufficient image quality from all four of OCT, angioscopy, intravascular ultrasound, and CT angiography. Intraluminal thrombus was assessed by OCT/angioscopy, and culprit lesions further classified by OCT-based demonstration of fibrous cap integrity. Of 35 culprit lesions with ACS, OCT revealed IFC with thrombus in 10 (29) and RFC in the remaining 25 (71); all 22 lesions with stable angina had intact fibrous caps. Fibrous caps were significantly thinner in RFC-ACS than IFC-ACS and stable angina (45 ± 12, 131 ± 57, and 321 ± 146 μm, respectively; P 0.001). CT angiography revealed that low-attenuation plaques were more frequently observed in RFC-ACS than IFC-ACS and stable angina (88, 40, and 18; P 0.001) lesions. Similarly, positive remodelling was more predominantly seen in RFC-ACS than IFC-ACS and stable angina (96, 20, and 14; P 0.001). However, none of the specific CT angiography features clearly distinguished IFC-ACS from stable lesions. ConclusionIn contrast to the situation with RFC-ACS, distinct culprit lesion characteristics associated with non-rupture-related mechanisms are not identified by CT angiography. It will therefore not be possible to differentiate plaques likely to develop IFC-ACS from stable plaques.

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U2 - 10.1093/eurheartj/ehr189

DO - 10.1093/eurheartj/ehr189

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