title: Invasive characterization of atherosclerotic plaque in patients with peripheral arterial disease using near-infrared spectroscopy intravascular ultrasound.
abstract: OBJECTIVE
  We describe the characteristics of atherosclerotic plaque in patients with peripheral arterial disease (PAD) using near-infrared spectroscopy-intravascular ultrasound (NIRS-IVUS) BACKGROUND: Imaging and autopsy studies have described atherosclerotic plaque in different vascular beds, including varying degrees of lipid, fibrosis, and calcification. Recently, NIRS has been validated as an accurate method for detecting lipid-core plaque (LCP) in the coronary circulation. Invasive evaluation of plaque composition using NIRS-IVUS has not been reported in different peripheral arterial circulations.
  
  
  METHODS
  We performed invasive angiography and NIRS-IVUS in consecutive PAD patients prior to percutaneous revascularization. Imaging evaluation included parameters from angiography, IVUS, and NIRS. NIRS-IVUS findings were compared among different vascular beds with regard to the presence and extent of calcification and LCP.
  
  
  RESULTS
  One hundred and forty-nine lesions in 126 PAD patients were enrolled, including the internal carotid (n = 10), subclavian/axillary (n = 9), renal (n = 14), iliac (n = 35), femoropopliteal (n = 69), and infrapopliteal (n = 12) arteries. Plaque morphology was calcified in 132 lesions (89%) and fibrous in 17 lesions (11%). Calcification varied from 100% of renal artery stenoses to 55% of subclavian/axillary artery stenoses. LCP was present in 48 lesions (32%) and prevalence varied from 60% in carotid artery stenoses to 0% in renal artery stenoses (P < 0.005). LCP was only observed in fibrocalcific plaque, and was longitudinally and circumferentially surrounded by a more extensive degree of calcium.
  
  
  CONCLUSIONS
  NIRS-IVUS in stable PAD patients demonstrates a high frequency of calcific plaque and statistically significant differences in the frequency of LCP in different arterial beds. LCP, when present in the peripheral circulation, is always associated with calcified plaque. The strong co-localization of calcified plaque and LCP in severe PAD lesions may provide plaque-stabilizing effects; further studies are needed. © 2017 Wiley Periodicals, Inc.
authors.affiliation: Department of Cardiovascular Medicine, Center for Innovation and Research in Cardiovascular Diseases, Beaumont Health, Royal Oak, Michigan.|Oakland University William Beaumont School of Medicine, Oakland County, Michigan.
authors.forename: Amr E
authors.identifier: http://orcid.org/0000-0002-7316-4247
authors.initials: AE
authors.lastname: Abbas
authors.affiliation: Department of Cardiovascular Medicine, Center for Innovation and Research in Cardiovascular Diseases, Beaumont Health, Royal Oak, Michigan.|Oakland University William Beaumont School of Medicine, Oakland County, Michigan.
authors.forename: Sibin K
authors.initials: SK
authors.lastname: Zacharias
authors.affiliation: Department of Cardiovascular Medicine, Center for Innovation and Research in Cardiovascular Diseases, Beaumont Health, Royal Oak, Michigan.|Oakland University William Beaumont School of Medicine, Oakland County, Michigan.
authors.forename: James A
authors.initials: JA
authors.lastname: Goldstein
authors.affiliation: Department of Cardiovascular Medicine, Center for Innovation and Research in Cardiovascular Diseases, Beaumont Health, Royal Oak, Michigan.|Oakland University William Beaumont School of Medicine, Oakland County, Michigan.
authors.forename: Ivan D
authors.initials: ID
authors.lastname: Hanson
authors.affiliation: Department of Cardiovascular Medicine, Center for Innovation and Research in Cardiovascular Diseases, Beaumont Health, Royal Oak, Michigan.|Oakland University William Beaumont School of Medicine, Oakland County, Michigan.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Safian
mesh_terms: D000368:Aged; D015901:Angiography, Digital Subtraction; D005260:Female; D005355:Fibrosis; D006801:Humans; D008055:Lipids / Q000032:analysis; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D019265:Spectroscopy, Near-Infrared / Q000379:methods*; D018084:Ultrasonography, Interventional / Q000379:methods*; D061205:Vascular Calcification / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology
chemical_list: D008055:Lipids
keywords: NIRS-IVUS; PAD; atherosclerosis; lipid-core plaque