title: Screening of ruptured plaques in patients with coronary artery disease by intravascular ultrasound.
abstract: OBJECTIVE
  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)% v 67.9 (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.
authors.affiliation: Department of Cardiology, University Essen, Hufelandstr 55, 45122 Essen, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Ge
authors.forename: F
authors.initials: F
authors.lastname: Chirillo
authors.forename: J
authors.initials: J
authors.lastname: Schwedtmann
authors.forename: G
authors.initials: G
authors.lastname: Görge
authors.forename: M
authors.initials: M
authors.lastname: Haude
authors.forename: D
authors.initials: D
authors.lastname: Baumgart
authors.forename: V
authors.initials: V
authors.lastname: Shah
authors.forename: C
authors.initials: C
authors.lastname: von Birgelen
authors.forename: S
authors.initials: S
authors.lastname: Sack
authors.forename: H
authors.initials: H
authors.lastname: Boudoulas
authors.forename: R
authors.initials: R
authors.lastname: Erbel
mesh_terms: D000328:Adult; D000368:Aged; D000789:Angina, Unstable / Q000000981:diagnostic imaging* / Q000209:etiology; D002118:Calcium / Q000032:analysis; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D012307:Risk Factors; D012422:Rupture, Spontaneous / Q000000981:diagnostic imaging; D018084:Ultrasonography, Interventional
chemical_list: D002118:Calcium