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culprit plaque

Gerard Pasterkamp, Hester M den Ruijter, Peter Libby
The concept of the 'vulnerable plaque' originated from pathological observations in patients who died from acute coronary syndrome. This recognition spawned a generation of research that led to greater understanding of how complicated atherosclerotic plaques form and precipitate thrombotic events. In current practice, an increasing number of patients who survive their first event present with non-ST-segment elevation myocardial infarction (NSTEMI) rather than myocardial infarction (MI) with ST-segment elevation (STEMI)...
October 20, 2016: Nature Reviews. Cardiology
Ana Blasco, Carmen Bellas, Leyre Goicolea, Ana Muñiz, Víctor Abraira, Ana Royuela, Susana Mingo, Juan Francisco Oteo, Arturo García-Touchard, Francisco Javier Goicolea
INTRODUCTION AND OBJECTIVES: Thrombus aspiration allows analysis of intracoronary material in patients with ST-segment elevation myocardial infarction. Our objective was to characterize this material by immunohistology and to study its possible association with patient progress. METHODS: This study analyzed a prospective cohort of 142 patients undergoing primary angioplasty with positive coronary aspiration. Histological examination of aspirated samples included immunohistochemistry stains for the detection of plaque fragments...
October 10, 2016: Revista Española de Cardiología
Mark W Kennedy, Enrico Fabris, Alexander J Ijsselmuiden, Holger Nef, Sebastian Reith, Javier Escaned, Fernando Alfonso, Niels van Royen, Wojtek Wojakowski, Adam Witkowski, Ciro Indolfi, Jan Paul Ottervanger, Harry Suryapranata, Elvin Kedhi
BACKGROUND: Fractional flow reserve (FFR) is a widely used tool for the identification of ischaemia-generating stenoses and to guide decisions on coronary revascularisation. However, the safety of FFR-based decisions in high-risk subsets, such as patients with Diabetes Mellitus (DM) or vulnerable stenoses presenting thin-cap fibro-atheroma (TCFA), is unknown. This study will examine the impact of optical coherence tomography (OCT) plaque morphological assessment and the identification of TCFA, in combination with FFR to better predict clinical outcomes in DM patients...
October 10, 2016: Cardiovascular Diabetology
Tsuyoshi Nishiguchi, Atsushi Tanaka, Akira Taruya, Hiroki Emori, Yuichi Ozaki, Makoto Orii, Yasutsugu Shiono, Kunihiro Shimamura, Takeyoshi Kameyama, Takashi Yamano, Tomoyuki Yamaguchi, Yoshiki Matsuo, Yasushi Ino, Takashi Kubo, Takeshi Hozumi, Yasushi Hayashi, Takashi Akasaka
OBJECTIVE: Early clinical presentation of ST-segment-elevation myocardial infarction (STEMI) and non-ST-segment-elevation myocardial infarction affects patient management. Although local inflammatory activities are involved in the onset of MI, little is known about their impact on early clinical presentation. This study aimed to investigate whether local inflammatory activities affect early clinical presentation. APPROACH AND RESULTS: This study comprised 94 and 17 patients with MI (STEMI, 69; non-STEMI, 25) and stable angina pectoris, respectively...
September 29, 2016: Arteriosclerosis, Thrombosis, and Vascular Biology
Hendrik H G Hansen, Gert Jan de Borst, Michiel L Bots, Frans L Moll, Gerard Pasterkamp, Chris L de Korte
BACKGROUND AND PURPOSE: Carotid plaque rupture is a major cause of stroke. Key issue for risk stratification is early identification of rupture-prone plaques. A noninvasive technique, compound ultrasound strain imaging, was developed providing high-resolution radial deformation/strain images of atherosclerotic plaques. This study aims at in vivo validation of compound ultrasound strain imaging in patients by relating the measured strains to typical features of vulnerable plaques derived from histology after carotid endarterectomy...
September 29, 2016: Stroke; a Journal of Cerebral Circulation
Milos Brankovic, K Martijn Akkerhuis, Nermina Buljubasic, Jin M Cheng, Rohit M Oemrawsingh, Hector M Garcia-Garcia, Evelyn Regar, Patrick W Serruys, Robert-Jan van Geuns, Eric Boersma, Isabella Kardys
BACKGROUND AND AIMS: We investigated whether plasma cystatin C (CysC) and neutrophil gelatinase-associated lipocalin (NGAL) are associated with intravascular ultrasound (IVUS)-derived characteristics of coronary atherosclerosis and 1-year adverse coronary events in patients with normal and mildly-to-moderately impaired kidney function. METHODS: Between 2008 and 2011, virtual histology (VH)-IVUS of a non-culprit coronary artery was performed in 581 patients undergoing coronary angiography...
September 17, 2016: Atherosclerosis
Carmine Siniscalchi, Claudio Reverberi, Nicola Gaibazzi
BACKGROUND AND AIM: Individuals with ischemia during cardiac stress-test (cST) have a high risk of developing myocardial infarction (MI), but the pathophysiologic mechanism has never been clarified. It is thought that non flow-limiting coronary plaques (FLP) cause more often MI than FLP, but this is in contradiction with the predictive value of cST. We investigated the correspondence between reversible ischemia and location of subsequent MI, since functional assessment shortly before MI could clarify whether the culprit plaque is a FLP or not...
2016: Acta Bio-medica: Atenei Parmensis
Shoichi Kuramitsu, Katsumi Miyauchi, Hiroyoshi Yokoi, Satoru Suwa, Yuji Nishizaki, Takayuki Yokoyama, Shuko Nojiri, Masashi Iwabuchi, Shinichi Shirai, Kenji Ando, Shinya Okazaki, Hiroshi Tamura, Hirotaka Watada, Hiroyuki Daida
BACKGROUND: Dipeptidyl peptidase-4 (DPP-4) inhibitors have anti-atherosclerotic and cardioprotective effects in vitro. However, the impact of DPP-4 inhibitors on coronary plaque remains unclear. We sought to assess the effect of sitagliptin on coronary plaque volume (PV) and stabilization in diabetic patients with acute coronary syndrome (ACS). METHODS: The ESPECIAL-ACS was a prospective, randomized, open-label, parallel group study at 4 Japanese centers to assess the effect of 6-month treatment with sitagliptin on coronary plaque changes in non-culprit lesion in diabetic patients with ACS using serial intravascular ultrasound (IVUS) and integrated backscatter IVUS (IB-IVUS) analysis...
September 15, 2016: Journal of Cardiology
Takumi Higuma, Tsunenari Soeda, Masahiro Yamada, Takashi Yokota, Hiroaki Yokoyama, Fumie Nishizaki, Lei Xing, Erika Yamamoto, Krzysztof Bryniarski, Jiannan Dai, Hang Lee, Ken Okumura, Ik-Kyung Jang
BACKGROUND: Previous studies reported that reduced TIMI (Thrombolysis in Myocardial Infarction) flow grade before procedure was associated with worse clinical outcomes in patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention. The aim of this study was to identify specific morphological characteristics of the culprit plaque associated with poor TIMI flow grade at baseline in patients with ST-segment-elevation myocardial infarction using both optical coherence tomography and intravascular ultrasound...
September 2016: Circulation. Cardiovascular Interventions
Na Zhao, Lan Mi, Yaping Zhang, Na Li, Jiaojiao Xu, Dongyu Xia, Junkui Wang, Yue Wu, Xiaojun Liu
OBJECTIVE: Neutrophils enhancing atherosclerotic plaque instability have been observed in patients with acute coronary syndrome (ACS). Generally, activation of neutrophils in lesions depends on the interaction of Fcγ receptors (FcγRs) with immunoglobulin G antibodies in immune complexes. However, altered FcγR expression on neutrophils of patients with ACS is unknown. We aimed to evaluate changes in FcγR expression on neutrophils of patients with ACS. METHODS: We enrolled 106 patients who were divided into four groups: acute myocardial infarction (AMI), unstable angina (UA), stable angina, and normal coronary arteries...
September 3, 2016: Coronary Artery Disease
Kevin Kris Warnakula Olesen, Trine Ørhøj Barkholt, Michael Maeng
PURPOSE: Coronary angiography provides no details on underlying pathology in acute coronary syndromes (ACS). Optical coherence tomography (OCT) can visualize coronary atherosclerosis, thrombus formation, and plaque rupture in patients with myocardial infarction (MI) where coronary angiography is unclear. MATERIALS AND METHODS: We present a case series containing 6 young patients with ACS, 4 of them due to non-obstructive thrombus, in whom the operators refrained from stent implantation despite an identifiable culprit lesion with OCT-validated thrombus formation...
September 5, 2016: Scandinavian Cardiovascular Journal: SCJ
Nana Dong, Zulong Xie, Jiannan Dai, Wei Wang, Rong Sun, Yefei Zhan, Meng Sun, Jinwei Tian, Bo Yu
AIMS: The incidence of cardiac events is increased in diabetic patients even after lipid-lowering therapy. This study aimed to compare the statin-induced changes in the characteristics of vulnerable plaques in patients without diabetes mellitus (DM) and in those with better- or poorly controlled DM, measured by optical coherence tomography (OCT). METHODS: This was a retrospective study of 99 non-culprit lipid-rich plaques from 75 patients who underwent intensive OCT imaging examination...
September 2, 2016: Acta Diabetologica
Vance T Lehman, Waleed Brinjikji, David F Kallmes, John Huston, Giussepe Lanzino, Rabinstein A Alejandro, Ashima Makol, Mahmud Mossa-Bosha
Intracranial arterial pathology has traditionally been evaluated with luminal imaging. Recently, high-resolution vessel wall imaging (HR-VWI) with MRI has facilitated sub-millimeter evaluation of the arterial walls. This technique can help differentiate various causes of intracranial steno-occlusive disease, identify culprit atherosclerotic plaques with a recent cerebral infarct, locate vessel wall pathology in areas with minimal or no narrowing on luminal imaging, predict aneurysm stability, and identify a ruptured aneurysm when multiple aneurysms are present...
September 2, 2016: British Journal of Radiology
Hiroki Ikenaga, Satoshi Kurisu, Shingo Kono, Yoji Sumimoto, Noriaki Watanabe, Takashi Shimonaga, Tadanao Higaki, Toshitaka Iwasaki, Naoya Mitsuba, Ken Ishibashi, Yoshihiro Dohi, Yukihiro Fukuda, Yasuki Kihara
BACKGROUND: Malondialdehyde-modified low-density lipoprotein (MDA-LDL) is considered to play an essential role in plaque destabilization. We aimed to investigate the association between the tissue characteristics of culprit plaque assessed by integrated backscatter (IB)-intravascular ultrasound (IVUS) and the serum MDA-LDL levels in patients with stable coronary artery disease. METHODS AND RESULTS: The study group consisted of 179 patients undergoing IB-IVUS during elective percutaneous coronary intervention...
September 23, 2016: Circulation Journal: Official Journal of the Japanese Circulation Society
Rohit M Oemrawsingh, Hector M Garcia-Garcia, Robert J M van Geuns, Mattie J Lenzen, Cihan Simsek, Sanneke P M de Boer, Nicolas M Van Mieghem, Evelyn Regar, Peter P T de Jaegere, K Martijn Akkerhuis, Jurgen M R Ligthart, Felix Zijlstra, Patrick W Serruys, Eric Boersma
AIMS: Statins are highly effective in reducing major adverse clinical events, but the direct effects on coronary plaque composition remain debatable. Our aim was to mechanistically evaluate the treatment effect of high-intensity statin therapy on compositional coronary plaque changes. METHODS AND RESULTS: The third Integrated Biomarker and Imaging Study (IBIS-3) was a prospective, investigator-initiated, single-centre study. Serial radiofrequency intravascular ultrasound (RF-IVUS) measurements of a predefined non-stenotic segment in a non-culprit coronary artery were performed to evaluate the effect of rosuvastatin (intended dose: 40 mg daily) on necrotic core (NC) volume in patients with stable angina or acute coronary syndrome...
August 20, 2016: EuroIntervention
Olli A Kajander, Natalia Pinilla-Echeverri, Sanjit S Jolly, Ravinay Bhindi, Heini Huhtala, Kari Niemelä, Anthony Fung, Ram Vijayaraghavan, Dimitrios Alexopoulos, Tej Sheth
AIMS: Our aim was to compare stenosis severity and plaque content between STEMI culprit lesions with intact fibrous cap (IFC) and those with plaque rupture (PR) in a prospective study. METHODS AND RESULTS: We evaluated 93 patients undergoing OCT and thrombectomy as part of a prospective substudy of the TOTAL (ThrOmbecTomy versus PCI ALone) trial. Culprit lesion morphology was assessable by OCT in 70/93 (75.3%). IFC was found in 31 (44.3%), PR in 34 (48.6%) and calcified nodule in five (7...
August 20, 2016: EuroIntervention
Charlie Chia-Tsong Hsu, Gigi Nga Chi Kwan, Dalveer Singh, Jit Pratap, Trevor William Watkins
Dual-energy computed tomography (DECT) simultaneously acquires images at two X-ray energy levels, at both high- and low-peak voltages (kVp). The material attenuation difference obtained from the two X-ray energies can be processed by software to analyze material decomposition and to create additional image datasets, namely, virtual noncontrast, virtual contrast also known as iodine overlay, and bone/calcium subtraction images. DECT has a vast array of clinical applications in imaging cerebrovascular diseases, which includes: (1) Identification of active extravasation of iodinated contrast in various types of intracranial hemorrhage; (2) differentiation between hemorrhagic transformation and iodine staining in acute ischemic stroke following diagnostic and/or therapeutic catheter angiography; (3) identification of culprit lesions in intra-axial hemorrhage; (4) calcium subtraction from atheromatous plaque for the assessment of plaque morphology and improved quantification of luminal stenosis; (5) bone subtraction to improve the depiction of vascular anatomy with more clarity, especially at the skull base; (6) metal artifact reduction utilizing virtual monoenergetic reconstructions for improved luminal assessment postaneurysm coiling or clipping...
2016: Journal of Clinical Imaging Science
Nobuo Shiode, Tomokazu Okimoto, Hiromichi Tamekiyo, Tomoharu Kawase, Kenichi Yamane, Yuzo Kagawa, Yuto Fujii, Yusuke Ueda, Naoya Hironobe, Yasuko Kato, Yasuhiko Hayashi
BACKGROUND: Generally, newly progressed coronary lesions (NPCLs) are considered to be composed of lipid-rich plaques. In case of vulnerable plaque rupture, they may quickly become culprit lesions responsible for acute coronary syndromes. METHODS: Between September 2011 and September 2015, 2034 patients underwent scheduled follow-up coronary angiography (CAG) after percutaneous coronary intervention (PCI) in Tsuchiya General Hospital. Patients with NPCLs found by CAG during the follow-up period were evaluated by optical coherence tomography (OCT)...
November 1, 2016: International Journal of Cardiology
Matjaz Klemenc, Gregor Budihna, Mateja Bedencic, Andrej Bartolic, Igor Kranjec
OBJECTIVES: We report on a young male athlete who suffered from acute myocardial infarction immediately after a vigorous training. METHODS: A comprehensive optical coherence tomographic investigation of the culprit coronary artery was performed after the combined mechanical and pharmacological thrombus removal. RESULTS AND CONCLUSION: The imaging discovered a tear at the junction of the non-obstructive, largely fibrotic plaque with the normal arterial wall...
2016: SAGE Open Med Case Rep
Fuyu Qiu, Gary S Mintz, Bernhard Witzenbichler, D Christopher Metzger, Michael J Rinaldi, Peter L Duffy, Giora Weisz, Thomas D Stuckey, Bruce R Brodie, Rupa Parvataneni, Ajay J Kirtane, Gregg W Stone, Akiko Maehara
OBJECTIVES: The aim of this study was to evaluate the prevalence and long-term clinical impact of tissue protrusion (TP) after stent implantation. BACKGROUND: Stent implantation may be associated with tissue (plaque or thrombus) protrusion, especially in unstable lesions, but its clinical impact is unknown. METHODS: ADAPT-DES (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents) was a prospective multicenter study of 8,663 patients undergoing percutaneous coronary intervention (PCI) using drug-eluting stents...
July 25, 2016: JACC. Cardiovascular Interventions
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