title: Virtual histology intravascular ultrasound comparison of coronary chronic total occlusions versus non-occlusive lesions.
abstract: To use virtual histology intravascular ultrasound (VH-IVUS) to assess the differences in tissue composition between chronic total occlusions (CTO) and non-occlusive lesions, especially in vivo. We compared 50 CTOs (49 patients) after guidewire crossing with 41 non-occlusive lesions (41 patients, 25 with unstable angina and 16 with stable angina). Overall, the percentage of necrotic core in the CTO segments was similar to non-occlusive lesions (35.6 vs. 38.7 %, p = 0.18 at the maximum necrotic core site; 24.2 vs. 23.7 %, p = 0.8 in mean analysis over the entire segment length). However, the percentage of dense calcium in CTO segments was less than in non-occlusive lesions (10.6 vs. 14.8 %, p = 0.025 at the maximum necrotic core site; 7.6 vs. 11.4 %, p = 0.036 in mean analysis over the entire segment length). Finally, the necrotic core/dense calcium ratio tended to be larger in the CTO segment than in non-occlusive lesions (2.94 vs. 2.35, p = 0.082 at the maximum necrotic core site; 3.05 vs. 2.03, p = 0.005 in mean analysis over the entire segment length). Overall, 42 (84 %) CTOs contained a fibroatheroma compared to 40 (97 %) of non-occulsive stenoses. The percentage of necrotic core in CTOs with a fibroathroma (39.0 %) was less than non-occlusive stenoses with a VH-thin cap fibroathroma (44.4 %, p = 0.017) and greater than non-occlusive stenoses with a VH-thick cap fibroathroma (33.5 %, p = 0.022) at maximum necrotic core site. These findings suggest that the morphological characteristics of most CTOs were similar as compared with non-CTO lesions and CTOs evolved from fibroatheromas.
authors.affiliation: Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY 10022, USA.
authors.forename: Jun
authors.initials: J
authors.lastname: Guo
authors.forename: Akiko
authors.initials: A
authors.lastname: Maehara
authors.forename: Ning
authors.initials: N
authors.lastname: Guo
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Ashida
authors.forename: Amala
authors.initials: A
authors.lastname: Chirumamilla
authors.forename: Yunpeng
authors.initials: Y
authors.lastname: Shang
authors.forename: Jun
authors.initials: J
authors.lastname: Pu
authors.forename: Elias
authors.initials: E
authors.lastname: Sanidas
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Moses
authors.forename: Martin B
authors.initials: MB
authors.lastname: Leon
authors.forename: Giora
authors.initials: G
authors.lastname: Weisz
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
authors.forename: Gary S
authors.initials: GS
authors.lastname: Mintz
authors.forename: Masahiko
authors.initials: M
authors.lastname: Ochiai
mesh_terms: D000368:Aged; D001208:Asia; D016009:Chi-Square Distribution; D002908:Chronic Disease; D002932:Cineangiography; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000000981:diagnostic imaging*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D018450:Disease Progression; D005060:Europe; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018084:Ultrasonography, Interventional; D014481:United States; D061205:Vascular Calcification / Q000000981:diagnostic imaging