Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
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Analysis of Plaque Composition in Coronary Chronic Total Occlusion Lesion Using Virtual Histology-Intravascular Ultrasound

  • Park, Yo-Han (Cardiology, Heart Center, Konyang University Hospital) ;
  • Kim, Yong-Kyun (Cardiology, Heart Center, Konyang University Hospital) ;
  • Seo, Duck-Jun (Cardiology, Heart Center, Konyang University Hospital) ;
  • Seo, Young-Hoon (Cardiology, Heart Center, Konyang University Hospital) ;
  • Lee, Chung-Seop (Cardiology, Heart Center, Konyang University Hospital) ;
  • Song, In-Geol (Cardiology, Heart Center, Konyang University Hospital) ;
  • Yang, Dong-Ju (Cardiology, Heart Center, Konyang University Hospital) ;
  • Kim, Ki-Hong (Cardiology, Heart Center, Konyang University Hospital) ;
  • Park, Hyun-Woong (Cardiology, Heart Center, Konyang University Hospital) ;
  • Kim, Wan-Ho (Cardiology, Andong Sungso Hospital) ;
  • Bae, Jang-Ho (Cardiology, Heart Center, Konyang University Hospital)
  • Received : 2015.04.15
  • Accepted : 2015.06.30
  • Published : 2016.01.30
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Abstract

Background and Objectives: Success rates of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) have recently been reported to range from 80% to 90%. A better understanding of the pathologic characteristics of the CTO lesion may helpful to improving CTO PCI success rates. We evaluated the CTO lesion in patients with stable angina (SA) by virtual histology-intravascular ultrasound (VH-IVUS). Subjects and Methods: The study population consisted of 149 consecutive patients with SA underwent VH-IVUS examination. We analyzed demographic and VH-IVUS findings in 22 CTO patients (17 males; mean, 62.3 years old) compared with 127 non-CTO patients (82 males; mean, 61.3 years old). Results: A significantly lower ejection fraction ($57.6{\pm}13.0%$ vs. $65.4{\pm}8.8%$, p=0.007) was detected in the CTO group compared with the non-CTO group. Reference vessel lumen area of the proximal and distal segment was significantly less in CTO group than in non-CTO-group. The lesion length of the CTO group was significantly longer than those of the non-CTO group ($24.4{\pm}9.6mm$ vs. $17.2{\pm}7.4mm$, p<0.001). Total atheroma volume ($224{\pm}159mm^3$ vs. $143{\pm}86mm^3$, p=0.006) and percent atheroma volume ($63.2{\pm}9.6%$ vs. $55.8{\pm}8.5%$, p=0.011) of the CTO group were also significantly greater than those of non-CTO group. However, the lesion length adjusted plaque composition of the CTO group was not significantly different compared with that of the non-CTO group. Conclusion: CTO lesions had a longer lesion length and greater plaque burden than the non-CTO lesion in patients with SA. However, lesion length adjusted plaque composition showed similar between the two groups. These results support that plaque characteristics of CTO lesions are similar to non-CTO lesions in patients with SA.

Keywords

References

  1. Brilakis ES, Karmpaliotis D, Vo MN, et al. Advances in the management of coronary chronic total occlusions. J Cardiovasc Transl Res 2014; 7:426-36. https://doi.org/10.1007/s12265-014-9556-6
  2. Fefer P, Knudtson ML, Cheema AN, et al. Current perspectives on coronary chronic total occlusions: the Canadian Multicenter Chronic Total Occlusions Registry. J Am Coll Cardiol 2012;59:991-7. https://doi.org/10.1016/j.jacc.2011.12.007
  3. Christofferson RD, Lehmann KG, Martin GV, Every N, Caldwell JH, Kapadia SR. Effect of chronic total coronary occlusion on treatment strategy. Am J Cardiol 2005;95:1088-91. https://doi.org/10.1016/j.amjcard.2004.12.065
  4. Werner GS, Gitt AK, Zeymer U, et al. Chronic total coronary occlusions in patients with stable angina pectoris: impact on therapy and outcome in present day clinical practice. Clin Res Cardiol 2009;98: 435-41. https://doi.org/10.1007/s00392-009-0013-5
  5. Jeroudi OM, Alomar ME, Michael TT, et al. Prevalence and management of coronary chronic total occlusions in a tertiary veterans affairs hospital. Catheter Cardiovasc Interv 2014;84:637-43. https://doi.org/10.1002/ccd.25264
  6. Grantham JA, Jones PG, Cannon L, Spertus JA. Quantifying the early health status benefits of successful chronic total occlusion recanalization: results from the FlowCardia's Approach to Chronic Total Occlusion Recanalization (FACTOR) trial. Circ Cardiovasc Qual Outcomes 2010;3:284-90. https://doi.org/10.1161/CIRCOUTCOMES.108.825760
  7. Joyal D, Afilalo J, Rinfret S. Effectiveness of recanalization of chronic total occlusions: a systematic review and meta-analysis. Am Heart J 2010;160:179-87. https://doi.org/10.1016/j.ahj.2010.04.015
  8. Olivari Z, Rubartelli P, Piscione F, et al. Immediate results and one-year clinical outcome after percutaneous coronary interventions in chronic total occlusions: data from a multicenter, prospective, observational study (TOAST-GISE). J Am Coll Cardiol 2003;41:1672-8. https://doi.org/10.1016/S0735-1097(03)00312-7
  9. Melchior JP, Doriot PA, Chatelain P, et al. Improvement of left ventricular contraction and relaxation synchronism after recanalization of chronic total coronary occlusion by angioplasty. J Am Coll Cardiol 1987;9: 763-8. https://doi.org/10.1016/S0735-1097(87)80230-9
  10. Hong YJ, Jeong MH, Choi YH, et al. Comparison of coronary plaque components between non-culprit lesions in patients with acute coronary syndrome and target lesions in patients with stable angina: virtual histology-intravascular ultrasound analysis. Korean Circ J 2013;43: 607-14. https://doi.org/10.4070/kcj.2013.43.9.607
  11. Stone GW, Kandzari DE, Mehran R, et al. Percutaneous recanalization of chronically occluded coronary arteries: a consensus document: part I. Circulation 2005;112:2364-72. https://doi.org/10.1161/CIRCULATIONAHA.104.481283
  12. Mintz GS, Nissen SE, Anderson WD, et al. American College of Cardiology Clinical Expert Consensus Document on standards for acquisition, measurement and reporting of Intravascular Ultrasound Studies (IVUS). A report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol 2001;37:1478-92. https://doi.org/10.1016/S0735-1097(01)01175-5
  13. Lee CS, Seo YH, Yang DJ, et al. Positive vascular remodeling in culprit coronary lesion is associated with plaque composition: an intravascular ultrasoundvirtual histology study. Korean Circ J 2012;42:747-52. https://doi.org/10.4070/kcj.2012.42.11.747
  14. Sakakura K, Nakano M, Otsuka F, et al. Comparison of pathology of chronic total occlusion with and without coronary artery bypass graft. Eur Heart J 2014;35:1683-93. https://doi.org/10.1093/eurheartj/eht422
  15. Srivatsa SS, Edwards WD, Boos CM, et al. Histologic correlates of angiographic chronic total coronary artery occlusions: influence of occlusion duration on neovascular channel patterns and intimal plaque composition. J Am Coll Cardiol 1997;29:955-63. https://doi.org/10.1016/S0735-1097(97)00035-1
  16. Guo J, Maehara A, Guo N, et al. Virtual histology intravascular ultrasound comparison of coronary chronic total occlusions versus non-occlusive lesions. Int J Cardiovasc Imaging 2013;29:1249-54. https://doi.org/10.1007/s10554-013-0222-x
  17. Guo J, Maehara A, Mintz GS, et al. A virtual histology intravascular ultrasound analysis of coronary chronic total occulusions. Catheter Cardiovasc Interv 2013;81:464-70. https://doi.org/10.1002/ccd.24356
  18. Missel E, Mintz GS, Carlier SG, et al. In vivo virtual histology intravascular ultrasound correlates of risk factors for sudden coronary death in men: results from the prospective, multi-centre virtual histology intravascular ultrasound registry. Eur Heart J 2008;29:2141-7. https://doi.org/10.1093/eurheartj/ehn293
  19. Missel E, Mintz GS, Carlier SG, et al. Necrotic core and its ratio to dense calcium are predictors of high-risk non-ST-elevation acute coronary syndrome. Am J Cardiol 2008;101:573-8. https://doi.org/10.1016/j.amjcard.2007.10.018

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