Thin cap fibroatheroma defined as lipid core abutting lumen (LCAL) on integrated backscatter intravascular ultrasound - comparison with optical coherence tomography and correlation with peri-procedural myocardial infarction.
BACKGROUND
This study evaluated the ability of a newly developed integrated backscatter intravascular ultrasound (IB-IVUS) system (VISIWAVE, Terumo, Tokyo, Japan) to detect optical coherence tomography (OCT)-verified thin cap fibroatheroma (TCFA) and assessed the correlation with peri-procedural myocardial infarction (PMI) after percutaneous coronary intervention (PCI).


RESULTS
One hundred culprit lesions in 100 consecutive patients with ischemic heart disease who consented to repeated IVUS and OCT prior to PCI were studied. Of 100 lesions, 48 had OCT-verified TCFA with a cap thickness <65 µm. Such lesions had larger percentage lipid area and lipid angle >2 quadrants on IB-IVUS. A lipid core abutting lumen (LCAL) was defined as a lipid core pool in the plaque area, directly contacting with the lumen regardless of its circumferential extension. IB-IVUS-identified TCFA defined as a combination of percentage lipid area ≥53.6%, remodeling index ≥1.03, and the presence of LCAL was the best predictor of OCT-verified TCFA with sensitivity, specificity, positive and negative predictive values, and accuracy of 72.9%, 90.4%, 87.5%, 78.3%, and 82.0%, respectively. IB-IVUS-identified TCFA as well as OCT-verified TCFA were significant independent predictors of PMI, after adjusting for other predictors on multivariate analysis.


CONCLUSIONS
IB-IVUS can be used to identify plaques with a high prevalence of TCFA. Such techniques can therefore potentially be used to identify lesions with an elevated risk of PMI after PCI.
Department of Cardiology, Fujita Health University Hospital.
Yukio
Y
Ozaki
Masaya
M
Ohota
Tevfik F
TF
Ismail
Masanori
M
Okumura
Masato
M
Ishikawa
Takashi
T
Muramatsu
D000368:Aged; D005260:Female; D006801:Humans; D008055:Lipids; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000473:pathology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D058226:Plaque, Atherosclerotic / Q000473:pathology / Q000601:surgery; D011183:Postoperative Complications / Q000473:pathology*; D041623:Tomography, Optical Coherence; D018084:Ultrasonography, Interventional
D008055:Lipids