title: The relationship between coronary plaque characteristics and small embolic particles during coronary stent implantation.
abstract: OBJECTIVE
  We investigated the relationship between coronary plaque components and small embolic particles during stenting and examined the influence on the coronary microcirculation.
  
  
  BACKGROUND
  In vivo tissue characterization of atherosclerotic plaques was introduced by the Virtual Histology intravascular ultrasound (VH-IVUS) system (Volcano Therapeutics, Inc., Rancho Cordova, California).
  
  
  METHODS
  The study consisted of 44 patients who underwent elective coronary stenting. Plaque characteristics were identified with VH-IVUS, and small embolic particles liberated during stenting were detected as high-intensity transient signals (HITS) with a Doppler guidewire. Coronary flow velocity reserve (CFVR) was also measured before and after stenting.
  
  
  RESULTS
  Patients were divided into the tertiles according to the HITS counts: the lowest, HITS <5 (n = 16); the middle, 5 to 12 (n = 15); and the highest, >12 (n = 13). Dense calcium and necrotic core area identified with VH-IVUS were significantly larger in the highest tertile (lowest vs. middle vs. highest; dense calcium: 0.2 +/- 0.3 mm2 vs. 0.3 +/- 0.6 mm2 vs. 0.8 +/- 0.7 mm2, p = 0.007; necrotic core: 0.5 +/- 0.4 mm2 vs. 0.9 +/- 0.9 mm2 vs. 1.8 +/- 1.0 mm2, p < 0.001, respectively). Multivariate logistic regression analysis revealed only necrotic core area was an independent predictor of high HITS counts (odds ratio 4.41, p = 0.045). Furthermore, there was a significant negative correlation between the HITS count and CFVR after stenting (r = -0.35, p = 0.017).
  
  
  CONCLUSIONS
  The necrotic core component identified with VH-IVUS is related to liberation of small embolic particles during coronary stenting, which results in the poorer recovery of CFVR.
authors.affiliation: Division of Cardiology, Kawasaki Medical School Hospital, Matsushima, Kurashiki, Japan. hokura@fides.dti.ne.jp
authors.forename: Takahiro
authors.initials: T
authors.lastname: Kawamoto
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Okura
authors.forename: Yuji
authors.initials: Y
authors.lastname: Koyama
authors.forename: Iku
authors.initials: I
authors.lastname: Toda
authors.forename: Haruyuki
authors.initials: H
authors.lastname: Taguchi
authors.forename: Koichi
authors.initials: K
authors.lastname: Tamita
authors.forename: Atsushi
authors.initials: A
authors.lastname: Yamamuro
authors.forename: Yuki
authors.initials: Y
authors.lastname: Yoshimura
authors.forename: Yoji
authors.initials: Y
authors.lastname: Neishi
authors.forename: Eiji
authors.initials: E
authors.lastname: Toyota
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Yoshida
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D023921:Coronary Stenosis / Q000209:etiology / Q000628:therapy*; D004617:Embolism / Q000209:etiology* / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008833:Microcirculation / Q000473:pathology; D011237:Predictive Value of Tests; D019919:Prosthesis Implantation / Q000009:adverse effects*; D015607:Stents; D018084:Ultrasonography, Interventional