title: Necrotic core and thin cap fibrous atheroma distribution in native coronary artery lesion-containing segments: a virtual histology intravascular ultrasound study.
abstract: OBJECTIVE
  The aim of this study was to assess the longitudinal topographical relationships between minimal luminal area (MLA) sites and plaques with the most vulnerable characteristics using radiofrequency-based virtual histology intravascular ultrasound analysis.
  
  
  METHODS
  We analyzed 69 native coronary artery segments with de-novo lesions (>50% stenosis) obtained from 50 patients with ischemic coronary artery disease. Maximal necrotic core (maxNC) was defined as a virtual histology intravascular ultrasound frame with the maxNC area and virtual histology-characterized thin cap fibrous atheroma was defined as a cross-section, which contained a plaque burden of more than 40%, relative necrotic core area of 10% or more, and a narrow band encircling the lumen containing relative necrotic core area of more than 10%, in three consecutive frames.
  
  
  RESULTS
  MaxNC was present at the MLA site in only 17.4% of the segments, proximal in 52.2% (by 5.0 ± 5.4 mm), and distal to MLA in 30.4% (by 4.0 ± 5.1 mm). Non-MLA sites with maxNC (n=57) compared with MLA sites had reduced plaque burden (64.5 ± 11.2% vs. 76.0 ± 10.5%, P<0.001), increased remodeling index (1.04 ± 0.17 vs. 0.89 ± 0.15, P<0.001), less fibrotic tissue (47.7 ± 13.4% vs. 54.8 ± 13.8%, P<0.001), and higher dense calcium deposition (15.3 ± 10.8% vs. 11.9 ± 10.3%, P<0.001). Plaques containing maxNC and virtual histology-characterized thin cap fibrous atheroma were found in 23 of the non-MLA sites compared with two of the MLA sites (P<0.0001).
  
  
  CONCLUSIONS
  In coronary artery segments with intermediate-to-severe stenosis, plaques containing maxNC are mostly located away from the MLA site and more often comprise virtual histology-characterized thin cap fibrous atheroma. Such data may carry practical implications for coronary revascularization procedures.
authors.affiliation: Interventional Cardiology Institute, Cardiology Department, Rabin Medical Center, Petach Tikva, Israel. sfuchsel2002@yahoo.com
authors.forename: Shmuel
authors.initials: S
authors.lastname: Fuchs
authors.forename: Ifat
authors.initials: I
authors.lastname: Lavi
authors.forename: Omer
authors.initials: O
authors.lastname: Tzang
authors.forename: Shir
authors.initials: S
authors.lastname: Fuchs
authors.forename: David
authors.initials: D
authors.lastname: Brosh
authors.forename: Tamir
authors.initials: T
authors.lastname: Bental
authors.forename: Danny
authors.initials: D
authors.lastname: Dvir
authors.forename: Shmuel
authors.initials: S
authors.lastname: Einav
authors.forename: Ran
authors.initials: R
authors.lastname: Kornowski
mesh_terms: D000368:Aged; D015331:Cohort Studies; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000000981:diagnostic imaging / Q000473:pathology; D058226:Plaque, Atherosclerotic / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D018084:Ultrasonography, Interventional / Q000379:methods*