Document Detail

Target lesion thin-cap fibroatheroma defined by virtual histology intravascular ultrasound affects microvascular injury during percutaneous coronary intervention in patients with angina pectoris.
MedLine Citation:
PMID:  20595776     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Several reports suggest that virtual histology intravascular ultrasound (VH-IVUS) assessment could predict microvascular damage during percutaneous coronary intervention (PCI). A novel index of microcirculatory resistance (IMR) has been developed as a reproducible and less hemodynamic-dependent index. The purpose of this study was to investigate the relationship between thin-cap fibroatheroma (TCFA) defined by VH-IVUS and a change in the IMR during PCI in patients with angina pectoris (AP).
METHODS AND RESULTS: The study investigated 30 lesions from 28 AP patients. VH-IVUS imaging was performed before PCI. TCFA was defined as the presence of confluent necrotic core (>10%) without detectable overlying fibrous cap segment. Patients were divided into 2 groups according to the presence of TCFA. Using a pressure guidewire, IMR were measured before and after PCI. After successful PCI, patients were prospectively followed up clinically. TCFA was detected in 9 lesions (30%). IMR tended to improve after PCI in the non-TCFA group, but tended to worsen in the TCFA group. DeltaIMR (=IMR after PCI-IMR before PCI) was significantly higher in the TCFA group compared with the non-TCFA group (13.2+/-29.9 vs -4.4+/-16.0, P=0.04). During follow-up (mean 20 months), survival free of major adverse cardiac events was significantly less in the TCFA group than in the non-TCFA group.
CONCLUSIONS: Target lesion TCFA may be related to both microvascular injury and the long-term clinical outcome after successful PCI in patients with AP.
Ryotaro Yamada; Hiroyuki Okura; Teruyoshi Kume; Yoji Neishi; Takahiro Kawamoto; Yoshinori Miyamoto; Koichiro Imai; Ken Saito; Tetsuo Tsuchiya; Akihiro Hayashida; Kiyoshi Yoshida
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Publication Detail:
Type:  Journal Article     Date:  2010-06-29
Journal Detail:
Title:  Circulation journal : official journal of the Japanese Circulation Society     Volume:  74     ISSN:  1347-4820     ISO Abbreviation:  Circ. J.     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-07-30     Completed Date:  2010-12-06     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101137683     Medline TA:  Circ J     Country:  Japan    
Other Details:
Languages:  eng     Pagination:  1658-62     Citation Subset:  IM    
Division of Cardiology, Kawasaki Medical School, Kurashiki, Japan.
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MeSH Terms
Aged, 80 and over
Angina Pectoris / therapy*
Angioplasty, Balloon, Coronary / adverse effects*
Microvessels / injuries*
Middle Aged
Plaque, Atherosclerotic / complications*,  diagnosis,  ultrasonography*
Treatment Outcome
Ultrasonography, Interventional
Vascular Resistance*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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