Coronary artery plaque formation at coronary CT angiography: morphological analysis and relationship to hemodynamics.
We aimed to demonstrate that coronary CT angiography (cCTA) can be used to non-invasively study the effect of hemodynamic factors in the pathophysiology of plaque formation. cCTA data of 73 patients were analyzed. All detected plaques were classified according to location (bifurcation, non-branching segment), configuration (eccentric, concentric), orientation (myocardial, lateral, epicardial side of the vessel wall), and composition (calcified, mixed, non-calcified). Bifurcation lesions were further characterized using the Medina classification. Of 382 plaques, 8.1% were in the LM, 46.3% in the LAD, 18.3% in the LCx, and 25.9% in the RCA. Also, 25.1% were completely calcified, 72.3% were mixed, and 2.6% were purely non-calcified. Of the plaques, 51.3% were bifurcation lesions. The most frequent (40%) Medina pattern was 1.1.0 (lesion starts before, extends beyond bifurcation, sparing the side branch). Eighty percent of plaques were eccentric. A significant (p < 0.01) majority (55%) were on the myocardial side, while 17.3% were lateral, and 27.7% epicardial. Of all non-calcified and mixed plaques, 45.1% (p < 0.01) were myocardial, whereas only 14.3% were lateral, 20.6% epicardial, and 19.9% concentric. We conclude that cCTA can non-invasively study the effect of vascular hemodynamics, such as turbulent flow (bifurcations) and low shear stress (myocardial vessel wall), on the distribution and composition of atherosclerotic plaque deposition.
Enrico
Benedetta
B
Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, Charleston, SC 29401, USA.
Suranyi
Pal
P
Thilo
Christian
C
Bonomo
Lorenzo
L
Costello
Philip
P
Schoepf
U Joseph
UJ
D000368:Aged; D050197:Atherosclerosis / Q000175:diagnosis / Q000473:pathology*; D001808:Blood Vessels / Q000473:pathology; D017023:Coronary Angiography / Q000295:instrumentation* / Q000379:methods*; D003331:Coronary Vessels / Q000473:pathology*; D004730:Endothelium, Vascular / Q000166:cytology / Q000473:pathology; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012306:Risk; D014057:Tomography, X-Ray Computed / Q000295:instrumentation* / Q000379:methods*