title: Near-Infrared Spectroscopy Analysis of Coronary Chronic Total Occlusions.
abstract: OBJECTIVE
  To examine the presence and localization of lipid-core plaque (LCP) in coronary vessels with chronic total occlusions (CTOs) using near-infrared spectroscopy (NIRS).
  
  
  METHODS
  NIRS imaging was performed after guidewire crossing of the occlusion in 15 patients with CTOs. LCP was defined as ≥2 adjacent 2 mm yellow blocks on the block chemogram. We also measured the maximum lipid-core burden index (LCBI) in a 4 mm length of artery (maxLCBI4mm). Large LCP was defined as maxLCBI4mm ≥500.
  
  
  RESULTS
  Median patient age was 64 years (interquartile range [IQR], 61-67 years) and all patients were men with high prevalence of diabetes mellitus (64%) and prior coronary artery bypass graft surgery (27%). The CTO target vessel was the right coronary artery (46%), left anterior descending artery (27%), or circumflex artery (27%). Median occlusion length was 35 mm (IQR, 30-50 mm). LCP was present in 11 of 15 CTO vessels (73%) and a large LCP in 4 of 15 CTO vessels (27%). LCP was located at the proximal cap in 6 CTOs (55%), the CTO body in 6 CTOs (55%), and the distal cap in 2 CTOs (18%). The median overall LCBI and maxLCBI4mm were 145 (IQR, 79-243) and 415 (IQR, 267-505), respectively. All patients underwent successful stenting without any complications. The 12-month incidence of in-stent restenosis and target-lesion revascularization was 25%, and all patients who developed restenosis had an LCP at baseline.
  
  
  CONCLUSIONS
  LCPs are commonly encountered in coronary CTO vessels, suggesting an active intraplaque atherosclerotic process. The impact of LCP on postintervention outcomes requires further study.
authors.forename: Georgios E
authors.initials: GE
authors.lastname: Christakopoulos
authors.forename: Judit
authors.initials: J
authors.lastname: Karacsonyi
authors.forename: Barbara Anna
authors.initials: BA
authors.lastname: Danek
authors.forename: Aris
authors.initials: A
authors.lastname: Karatasakis
authors.forename: Aya
authors.initials: A
authors.lastname: Alame
authors.forename: Pratik
authors.initials: P
authors.lastname: Kalsaria
authors.forename: Atif
authors.initials: A
authors.lastname: Mohammed
authors.forename: Michele
authors.initials: M
authors.lastname: Roesle
authors.forename: Bavana V
authors.initials: BV
authors.lastname: Rangan
authors.forename: Subhash
authors.initials: S
authors.lastname: Banerjee
authors.affiliation: Minneapolis Heart Institute, 920 E. 28th Street #300, Minneapolis, MN 55407 USA. esbrilakis@ gmail.com.
authors.forename: Emmanouil S
authors.initials: ES
authors.lastname: Brilakis
mesh_terms: D000368:Aged; D015897:Comorbidity; D017023:Coronary Angiography / Q000379:methods; D001026:Coronary Artery Bypass / Q000379:methods*; D054059:Coronary Occlusion / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology; D003920:Diabetes Mellitus / Q000453:epidemiology*; D006801:Humans; D008055:Lipids / Q000032:analysis; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000737:chemistry / Q000150:complications / Q000000981:diagnostic imaging; D011300:Preoperative Care / Q000379:methods; D012720:Severity of Illness Index; D019265:Spectroscopy, Near-Infrared / Q000379:methods*; D016896:Treatment Outcome; D014481:United States
chemical_list: D008055:Lipids