RT Journal Article
SR Electronic
T1 Screening of ruptured plaques in patients with coronary artery disease by intravascular ultrasound
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 621
OP 627
DO 10.1136/hrt.81.6.621
VO 81
IS 6
A1 J Ge
A1 F Chirillo
A1 J Schwedtmann
A1 G Görge
A1 M Haude
A1 D Baumgart
A1 V Shah
A1 C von Birgelen
A1 S Sack
A1 H Boudoulas
A1 R Erbel
YR 1999
UL http://heart.bmj.com/content/81/6/621.abstract
AB AIM To visualise the characteristics of ruptured plaques by intravascular ultrasound (IVUS) and to correlate plaque characteristics with clinical symptoms to establish a quantitative index of plaque vulnerability.METHODS 144 consecutive patients with angina were examined using IVUS. Ruptured plaques, characterised by a plaque cavity and a tear on the thin fibrous cap, were identified in 31 patients (group A), of whom 23 (74%) presented with unstable angina. Plaque rupture was confirmed by injecting contrast medium filling the plaque cavity during IVUS examination. Of the patients without plaque rupture (group B, n = 108), only 19 (18%) had unstable angina.RESULTS No significant differences were found between groups A and B in relation to plaque and vessel area (p > 0.05). Mean (SD) per cent stenosis in group A was less than in group B, at 56.2 (16.5)% v67.9 (13.4)%; p < 0.001. Area of the emptied plaque cavity in group A (4.1 (3.2) mm2) was larger than the echolucent zone in group B (1.32 (0.79) mm2) (p < 0.001). The plaque cavity to plaque ratio in group A (38.5 (17.1)%) was larger than the echolucent area to plaque ratio in group B (11.2 (8.9)%) (p < 0.001). The thickness of the fibrous cap in group A was less than in group B, at 0.47 (0.20) mm v 0.96 (0.94) mm; p < 0.001.CONCLUSIONS Plaques seem to be prone to rupture when the echolucent area is larger than 4.1 (3.2) mm2, when the echolucent area to plaque ratio is greater than 38.5 (17.1)%, and when the fibrous cap is thinner than 0.7 mm. IVUS can identify plaque rupture and vulnerable plaques. This may influence patient management and treatment.