title: Vasa Vasorum Restructuring in Human Atherosclerotic Plaque Vulnerability: A Clinical Optical Coherence Tomography Study.
abstract: BACKGROUND
  Previous studies have suggested that vasa vasorum (VV) is associated with plaque progression and vulnerability.
  
  
  OBJECTIVE
  The aim of this study was to investigate the relationship between coronary neovascularization structures and plaque characteristics.
  
  
  METHODS
  We included 53 patients who underwent optical coherence tomography to observe the proximal left anterior descending coronary artery. Patients were classified into 5 groups according to lesion characteristics: normal; fibrous plaque (FP); fibroatheroma (FA); plaque rupture (PR); and fibrocalcific plaque (FC). We defined signal-poor tubuloluminal structures recognized in cross-sectional and longitudinal profiles located in adventitial layer as VV, and within plaque as intraplaque neovessels. Two types of longitudinal microvascular structure (external running and internal running) and a particular type of intraplaque neovessels (a coral tree pattern) were noted. All VV and intraplaque neovessels were manually segmented followed by quantification with Simpson method.
  
  
  RESULTS
  Among the groups, there was significant difference (expressed as median [interquartile range (IQR)]) in VV volume (normal: 0.329 [IQR: 0.209 to 0.361] mm(3), FP: 0.433 [IQR: 0.297 to 0.706] mm(3), FA: 0.288 [IQR: 0.113 to 0.364] mm(3), PR: 0.160 [IQR: 0.141 to 0.193] mm(3), and FC: 0.106 [IQR: 0.053 to 0.165] mm(3); p = 0.003) and intraplaque neovessels volume (normal: 0.00 [IQR: 0.00 to 0.00] mm(3), FP: 0.00 [IQR: 0.00 to 0.00] mm(3), FA: 0.028 [IQR: 0.019 to 0.041] mm(3), PR: 0.035 [IQR: 0.026 to 0.042] mm(3), and FC: 0.010 [IQR: 0.005 to 0.014] mm(3); p < 0.001). Significant differences were observed in the prevalence of the internal running (normal: 0.0%, FP: 28.6%, FA: 40.0%, PR: 70.0%, and FC: 40.0%; p = 0.032) and the coral tree pattern (normal: 0.0%, FP: 7.1%, FA: 40.0%, PR: 80.0%, and FC: 10.0%; p < 0.01). The VV volume correlated with fibrous plaque volume (r = 0.71; p < 0.01).
  
  
  CONCLUSIONS
  VV increase with fibrous plaque volume and intraplaque neovessels with particular structures are associated with plaque vulnerability. Imaging for microvasculature could become a new window for plaque vulnerability.
authors.affiliation: Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Taruya
authors.affiliation: Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan. Electronic address: a-tanaka@wakayama-med.ac.jp.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Tanaka
authors.affiliation: Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Nishiguchi
authors.affiliation: Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Matsuo
authors.affiliation: Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Ozaki
authors.affiliation: Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Kashiwagi
authors.affiliation: Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Yasutsugu
authors.initials: Y
authors.lastname: Shiono
authors.affiliation: Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Orii
authors.affiliation: Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Yamano
authors.affiliation: Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Ino
authors.affiliation: Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Kumiko
authors.initials: K
authors.lastname: Hirata
authors.affiliation: Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kubo
authors.affiliation: Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Akasaka
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging / Q000503:physiopathology; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011859:Radiography; D041623:Tomography, Optical Coherence / Q000379:methods* / Q000639:trends; D014651:Vasa Vasorum / Q000000981:diagnostic imaging* / Q000503:physiopathology
keywords: optical coherence tomography; plaque progression; plaque rupture; vasa vasorum; vulnerable plaque