Morphologic and angiographic features of coronary plaque rupture detected by intravascular ultrasound.
OBJECTIVE
This study was designed to report the clinical and angiographic correlates of plaque rupture detected by intravascular ultrasound (IVUS).


BACKGROUND
Acute coronary syndromes result from spontaneous plaque rupture and thrombosis.


METHODS
We report 300 plaque ruptures in 257 arteries in 254 patients. Plaque ruptures were detected during pre-intervention IVUS. Standard clinical, angiographic, and IVUS parameters were collected and/or measured. One lesion per patient was analyzed.


RESULTS
Multiple ruptures were observed in 39 of 254 patients (15%), 36 in the same artery. Plaque rupture occurred not only in patients with unstable angina (46%) or myocardial infarction (MI, 33%), but also stable angina (11%) or no symptoms (11%). The tear in the fibrous cap could be identified in 157 of 254 patients; 63% occurred at the shoulder of the plaque and 37% in the center of the plaque. Thrombi were more common in patients with unstable angina or MI (p = 0.02) and in multiple ruptures (p = 0.04). The plaque rupture site contained the minimum lumen area (MLA) site in only 28% of patients; rupture sites had larger arterial and lumen areas and more positive remodeling than MLA sites. Intravascular ultrasound plaque rupture strongly correlated with complex angiographic lesion morphology: ulceration in 81%, intimal flap in 40%, thrombus in 7%, and aneurysm in 7%.


CONCLUSIONS
Plaque ruptures occur with varying clinical presentations, strongly correlate with angiographic complex lesion morphology, may be multiple, and usually do not cause lumen compromise.
Maehara
Akiko
A
Cardiovascular Research Institute, Washington Hospital Center, Washington, DC 20010, USA.
Mintz
Gary S
GS
Bui
Anh B
AB
Walter
Olga R
OR
Castagna
Marco T
MT
Canos
Daniel
D
Pichard
August D
AD
Satler
Lowell F
LF
Waksman
Ron
R
Suddath
William O
WO
Laird
John R
JR
Kent
Kenneth M
KM
Weissman
Neil J
NJ
D000787:Angina Pectoris / Q000000981:diagnostic imaging; D000789:Angina, Unstable / Q000000981:diagnostic imaging; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging; D012422:Rupture, Spontaneous; D018084:Ultrasonography, Interventional