title: Impact of plaque components on no-reflow phenomenon after stent deployment in patients with acute coronary syndrome: a virtual histology-intravascular ultrasound analysis.
abstract: OBJECTIVE
  We used virtual histology-intravascular ultrasound (VH-IVUS) to evaluate the relation between coronary plaque characteristics and no-reflow in acute coronary syndrome (ACS) patients.
  
  
  RESULTS
  A total of 190 consecutive ACS patients were imaged using VH-IVUS and analysed retrospectively. Angiographic no-reflow was defined as TIMI flow grade 0, 1, and 2 after stenting. Virtual histology-intravascular ultrasound classified the colour-coded tissue into four major components: fibrotic, fibro-fatty, dense calcium, and necrotic core (NC). Thin-cap fibroatheroma (TCFA) was defined as focal, NC-rich (≥10% of the cross-sectional area) plaques being in contact with the lumen in a plaque burden≥40%. Of the 190 patients studied at pre-stenting, no-reflow was observed in 24 patients (12.6%) at post-stenting. The absolute and %NC areas at the minimum lumen sites (1.6±1.2 vs. 0.9±0.8 mm2, P<0.001, and 24.5±14.3 vs. 16.1±10.6%, P=0.001, respectively) and the absolute and %NC volumes (30±24 vs. 16±17 mm3, P=0.001, and 22±11 vs. 14±8%, P<0.001, respectively) were significantly greater, and the presence of at least one TCFA and multiple TCFAs within culprit lesions (71 vs. 36%, P=0.001, and 38 vs. 15%, P=0.005, respectively) was significantly more common in the no-reflow group compared with the normal-reflow group. In the multivariable analysis, %NC volume was the only independent predictor of no-reflow (odds ratio=1.126; 95% CI 1.045-1.214, P=0.002).
  
  
  CONCLUSIONS
  In ACS patients, post-stenting no-reflow is associated with plaque components defined by VH-IVUS analysis with larger NC and more TCFAs.
authors.affiliation: Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, 671 Jaebongro, Dong-gu, Gwangju 501-757, Republic of Korea.
authors.forename: Young Joon
authors.initials: YJ
authors.lastname: Hong
authors.forename: Myung Ho
authors.initials: MH
authors.lastname: Jeong
authors.forename: Yun Ha
authors.initials: YH
authors.lastname: Choi
authors.forename: Jum Suk
authors.initials: JS
authors.lastname: Ko
authors.forename: Min Goo
authors.initials: MG
authors.lastname: Lee
authors.forename: Won Yu
authors.initials: WY
authors.lastname: Kang
authors.forename: Shin Eun
authors.initials: SE
authors.lastname: Lee
authors.forename: Soo Hyun
authors.initials: SH
authors.lastname: Kim
authors.forename: Keun Ho
authors.initials: KH
authors.lastname: Park
authors.forename: Doo Sun
authors.initials: DS
authors.lastname: Sim
authors.forename: Nam Sik
authors.initials: NS
authors.lastname: Yoon
authors.forename: Hyun Ju
authors.initials: HJ
authors.lastname: Youn
authors.forename: Kye Hun
authors.initials: KH
authors.lastname: Kim
authors.forename: Hyung Wook
authors.initials: HW
authors.lastname: Park
authors.forename: Ju Han
authors.initials: JH
authors.lastname: Kim
authors.forename: Youngkeun
authors.initials: Y
authors.lastname: Ahn
authors.forename: Jeong Gwan
authors.initials: JG
authors.lastname: Cho
authors.forename: Jong Chun
authors.initials: JC
authors.lastname: Park
authors.forename: Jung Chaee
authors.initials: JC
authors.lastname: Kang
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D054318:No-Reflow Phenomenon / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D058226:Plaque, Atherosclerotic / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D015607:Stents; D018084:Ultrasonography, Interventional