Evaluation of plaque stabilization by fluvastatin with carotid intima- medial elasticity measured by a transcutaneous ultrasonic-based tissue characterization system.
OBJECTIVE
As an approach to tissue characterization, we attempted to classify in vivo carotid plaque tissues in terms of arterial wall elasticity instead of echogenicity on B-mode scanning and investigated whether the effect of fluvastatin on carotid elasticity can be detected in hypercholesterolemic patients.


METHODS
In 170 subjects, simultaneous measurements of intima-media thickness (IMT) and elastic modulus in the circumferential direction (E(theta)) were performed using a new transcutaneous high-resolution Doppler technique.


RESULTS
From the observation of various tissues, an elasticity library was obtained as follows: lipid core, 22+/-15 kPa; calcification, 674+/-384 kPa; lipid core- and calcification-free plaques, 173+/-69 kPa; smooth muscle, 104+/-32 kPa; blood clot, 85+/-68 kPa; fibrosis, 273+/-173 kPa.The effect of fluvastatin (30 mg/day, n=62) was assessed over 12 months using the elasticity distribution and serum markers. The statin reduced low-density lipoprotein cholesterol, high-sensitivity CRP, mean IMT and mean E(theta), and increased nitrite/nitrate. In the max IMT > or =1.1 mm group, both E(theta) and IMT decreased significantly. On the other hand, in the max IMT <1.1 mm group, E(theta) but not IMT decreased significantly. The histogram of the subgroups showing increased E(theta) with max IMT> or =1.1 mm revealed a decrease in areas corresponding to E(theta) of 20200 kPa (lipid/smooth muscle-rich tissue) and an increase in relatively hardened areas of <250 kPa (collagen fibers).


CONCLUSIONS
Non-invasive echographic carotid arterial elasticity measurement is useful for the classification of atherosclerotic plaques and evaluation of chronological and histopathological changes.
Yamagishi
Toshio
T
Department of Internal Medicine, Tohoku Kosai Hospital, Japan. tyamagishi@tohokukosai.com
Kato
Makoto
M
Koiwa
Yoshiro
Y
Omata
Ken
K
Hasegawa
Hideyuki
H
Kanai
Hiroshi
H
D000328:Adult; D000368:Aged; D050197:Atherosclerosis / Q000473:pathology*; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000187:drug effects*; D016022:Case-Control Studies; D004341:Drug Evaluation; D005229:Fatty Acids, Monounsaturated / Q000494:pharmacology*; D000077340:Fluvastatin; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000494:pharmacology*; D007211:Indoles / Q000494:pharmacology*; D008875:Middle Aged; D017539:Tunica Intima / Q000000981:diagnostic imaging / Q000187:drug effects*; D014463:Ultrasonography
D005229:Fatty Acids, Monounsaturated; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007211:Indoles; D000077340:Fluvastatin