Morphologic and angiographic features of coronary plaque rupture detected by intravascular ultrasound

• Published in: Journal of the American College of Cardiology Vol. 40; no. 5; pp. 904 - 910
• Main Authors: Maehara, Akiko, Mintz, Gary S., Bui, Anh B., Walter, Olga R., Castagna, Marco T., Canos, Daniel, Pichard, August D., Satler, Lowell F., Waksman, Ron, Suddath, William O., Laird, John R., Kent, Kenneth M., Weissman, Neil J.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 04.09.2002; Elsevier Science; Elsevier Limited
• Subjects: Angina Pectoris - diagnostic imaging; Angina, Unstable - diagnostic imaging; Biological and medical sciences; Cardiology; Cardiovascular system; Coronary Angiography; Coronary vessels; Coronary Vessels - diagnostic imaging; Female; Heart attacks; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Myocardial Infarction - diagnostic imaging; Rupture, Spontaneous; Ultrasonic investigative techniques; Ultrasonography, Interventional; Veins & arteries; CSA; MLA; PCI; IVUS; CABG; EEM; MI; Sonography; Human; Radiodiagnosis; Pathophysiology; Atherosclerotic plaque; Morphological analysis; Rupture; Cardiovascular disease; Exploration; Endovascular route; Coronary arteriography; Coronary heart disease
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/S0735-1097(02)02047-8

This study was designed to report the clinical and angiographic correlates of plaque rupture detected by intravascular ultrasound (IVUS). Acute coronary syndromes result from spontaneous plaque rupture and thrombosis. We report 300 plaque ruptures in 257 arteries in 254 patients. Plaque ruptures were detected during pre-intervention IVUS. Standard clinical, angiographic, and IVUS parameters were collected and/or measured. One lesion per patient was analyzed. Multiple ruptures were observed in 39 of 254 patients (15%), 36 in the same artery. Plaque rupture occurred not only in patients with unstable angina (46%) or myocardial infarction (MI, 33%), but also stable angina (11%) or no symptoms (11%). The tear in the fibrous cap could be identified in 157 of 254 patients; 63% occurred at the shoulder of the plaque and 37% in the center of the plaque. Thrombi were more common in patients with unstable angina or MI (p = 0.02) and in multiple ruptures (p = 0.04). The plaque rupture site contained the minimum lumen area (MLA) site in only 28% of patients; rupture sites had larger arterial and lumen areas and more positive remodeling than MLA sites. Intravascular ultrasound plaque rupture strongly correlated with complex angiographic lesion morphology: ulceration in 81%, intimal flap in 40%, thrombus in 7%, and aneurysm in 7%. Plaque ruptures occur with varying clinical presentations, strongly correlate with angiographic complex lesion morphology, may be multiple, and usually do not cause lumen compromise.