title: Ruptured plaque and large plaque burden are risks of distal embolisation during percutaneous coronary intervention: evaluation by angioscopy and virtual histology intravascular ultrasound imaging.
abstract: OBJECTIVE
  Slow flow and no flow phenomena have been associated with distal embolisation, especially of plaque debris, and with unfavourable clinical outcomes. However, patients at high risk of distal embolisation for whom distal protection might be beneficial have not been adequately identified. We examined the frequency of distal embolisation and its predicting factors, including both ACS and non-ACS patients.
  
  
  RESULTS
  Consecutive patients (n=98) with or without ACS who had received PCI with a filter-type distal protection device and successful angioscopic and VH-IVUS examination were prospectively enrolled. The presence of yellow plaque and plaque rupture was evaluated by angioscopy. Tissue classification and plaque burden was evaluated by VH-IVUS. Distal embolisation was evaluated by pathological examination of material collected in the filter. Distal embolisation of plaque debris was more frequently detected in patients with ACS (48% vs. 25%, p=0.02), in those with ruptured plaque (86% vs. 13%, p<0.001), in those with large (>75%) plaque burden (50% vs. 23%, p=0.006), and in those with grade 2/3 yellow plaque (52% vs. 7%, p<0.001), as compared to those without it.
  
  
  CONCLUSIONS
  The presence of ruptured yellow plaque and of large plaque burden, rather than the setting of ACS, was highly predictive of distal embolisation of plaque debris.
authors.affiliation: Cardiovascular Division, Osaka Police Hospital, Osaka, Japan.
authors.forename: Koshi
authors.initials: K
authors.lastname: Matsuo
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Ueda
authors.forename: Masahiko
authors.initials: M
authors.lastname: Tsujimoto
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Hao
authors.forename: Mayu
authors.initials: M
authors.lastname: Nishio
authors.forename: Akio
authors.initials: A
authors.lastname: Hirata
authors.forename: Mitsutoshi
authors.initials: M
authors.lastname: Asai
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Nemoto
authors.forename: Ayaka
authors.initials: A
authors.lastname: Murakami
authors.forename: Kazunori
authors.initials: K
authors.lastname: Kashiwase
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Kodama
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D000368:Aged; D017546:Angioscopy; D016009:Chi-Square Distribution; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000473:pathology*; D057505:Embolic Protection Devices; D004617:Embolism / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000295:instrumentation; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D012422:Rupture, Spontaneous; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional