Top

Published in:

01-07-2019 | Myocardial Infarction | Original Article

Plaque characteristics and slow flow during percutaneous coronary intervention of irregular protrusion by optical coherence tomography

Authors: Hideo Amano, Ryota Noike, Daiga Saito, Takayuki Yabe, Ippei Watanabe, Ryo Okubo, Masayuki Koizumi, Mikihito Toda, Takanori Ikeda

Published in: Heart and Vessels | Issue 7/2019

Abstract

Irregular protrusion on optical coherence tomography (OCT) is associated with clinical events and target lesion revascularization. We investigated clinical and procedure characteristics, plaque characteristics, slow flow after stent implantation, and clinical outcomes with irregular protrusion using OCT. Eighty-four lesions in 76 patients undergoing OCT before percutaneous coronary intervention were evaluated. Irregular protrusion was defined as protrusion of material with an irregular surface into the lumen between stent struts with a maximum height of ≥100 μm. Lesions with irregular protrusion were found in 56% (47/84). Compared with lesions without irregular protrusion, those with irregular protrusion had significantly higher low-density lipoprotein cholesterol (LDL-C) levels (108 ± 31 mg/dl vs. 95 ± 25 mg/dl, P = 0.044); a tendency toward decreased use of statins [44% (19/43) vs. 67% (22/33), P = 0.065]; significantly larger reference vessel diameter (3.12 ± 0.53 mm vs. 2.74 ± 0.63 mm, P = 0.004); more frequent slow flow after stent implantation [38% (18/47) vs. 11% (4/37), P = 0.006]; higher incidence of thin-cap fibroatheromas [TCFAs; 49% (23/47) vs. 5% (2/37), P < 0.001]; plaque rupture [40% (19/47) vs. 16% (6/37), P = 0.018]; and a tendency higher incidence of 1-year adverse clinical outcomes (death, acute myocardial infarction, acute coronary syndrome, or target lesion revascularization) [12% (5/43) vs. 0% (0/33), P = 0.075]. In conclusion, irregular protrusion on OCT was associated with high plaque vulnerability, higher LDL-C, less frequent use of statin, larger vessel diameter, slow flow after stent implantation, and 1-year adverse clinical outcomes.

Farb A, Weber DK, Kolodgie FD, Burke AP, Virmani R (2002) Morphological predictors of restenosis after coronary stenting in humans. Circulation 105:2974–2980CrossRefPubMed

Nakano M, Yahagi K, Otsuka F, Sakakura K, Finn AV, Kutys R, Ladich E, Fowler DR, Joner M, Virmani R (2014) Causes of early stent thrombosis in patients presenting with acute coronary syndrome: an ex vivo human autopsy study. J Am Coll Cardiol 63:2510–2520CrossRefPubMed

Soeda T, Uemura S, Park SJ, Jang Y, Lee S, Cho JM, Kim SJ, Vergallo R, Minami Y, Ong DS, Gao L, Lee H, Zhang S, Yu B, Saito Y, Jang IK (2015) Incidence and clinical significance of poststent optical coherence tomography findings: one-year follow-up study from a multicenter registry. Circulation 132:1020–1029CrossRefPubMed

Sugiyama T, Kimura S, Ohtani H, Hishikari K, Kojima K, Sagawa Y, Hayasaka K, Mizusawa M, Misawa T, Yamakami Y, Hikita H, Takahashi A, Isobe M (2017) Relationship between quantities of tissue prolapse after percutaneous coronary intervention and neointimal hyperplasia at follow-up on serial optical coherence tomography examination. Int J Cardiol 241:470–477CrossRefPubMed

Huang D, Swanson EA, Lin CP, Schuman JS, Stinson WG, Chang W, Hee MR, Flotte T, Gregory K, Puliafito CA (1991) Optical coherence tomography. Science 254:1178–1181CrossRefPubMedPubMedCentral

Niccoli G, Burzotta F, Galiuto L, Crea F (2009) Myocardial no-reflow in humans. J Am Coll Cardiol 54:281–292CrossRefPubMed

Tanaka A, Imanishi T, Kitabata H, Kubo T, Takarada S, Tanimoto T, Kuroi A, Tsujioka H, Ikejima H, Komukai K, Kataiwa H, Okouchi K, Kashiwaghi M, Ishibashi K, Matsumoto H, Takemoto K, Nakamura N, Hirata K, Mizukoshi M, Akasaka T (2009) Lipid-rich plaque and myocardial perfusion after successful stenting in patients with non-ST-segment elevation acute coronary syndrome: an optical coherence tomography study. Eur Heart J 30:1348–1355CrossRefPubMed

Gamou T, Sakata K, Matsubara T, Yasuda T, Miwa K, Inoue M, Kanaya H, Konno T, Hayashi K, Kawashiri M, Yamagishi M (2015) Impact of thin-cap fibroatheroma on predicting deteriorated coronary flow during interventional procedures in acute as well as stable coronary syndromes: insights from optical coherence tomography analysis. Heart Vessels 30:719–727CrossRefPubMed

Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F, Bax JJ, Borger MA, Brotons C, Chew DP, Gencer B, Hasenfuss G, Kjeldsen K, Lancellotti P, Landmesser U, Mehilli J, Mukherjee D, Storey RF, Windecker S (2016) 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: task Force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European society of cardiology (ESC). Eur Heart J 37:267–315CrossRef

10.

The TIMI Study Group (1985) The thrombolysis in myocardial infarction (TIMI) trial. Phase I findings. N Engl J Med 312:932–936CrossRef

11.

Kitabata H, Kubo T, Komukai K, Ishibashi K, Tanimoto T, Ino Y, Takarada S, Ozaki Y, Kashiwagi M, Orii M, Shiono Y, Shimamura K, Hirata K, Tanaka A, Kimura K, Mizukoshi M, Imanishi T, Akasaka T (2012) Effect of strut thickness on neointimal atherosclerotic change over an extended follow-up period (≥ 4 years) after bare-metal stent implantation: intracoronary optical coherence tomography examination. Am Heart J 163:608–616CrossRefPubMed

12.

Prati F, Regar E, Mintz GS, Arbustini E, Di Mario C, Jang IK, Akasaka T, Costa M, Guagliumi G, Grube E, Ozaki Y, Pinto F, Serruys PW (2010) Expert review document on methodology, terminology, and clinical applications of optical coherence tomography: physical principles, methodology of image acquisition, and clinical application for assessment of coronary arteries and atherosclerosis. Eur Heart J 31:401–415CrossRefPubMed

13.

Tearney GJ, Regar E, Akasaka T, Adriaenssens T, Barlis P, Bezerra HG, Bouma B, Bruining N, Cho JM, Chowdhary S, Costa MA, de Silva R, Dijkstra J, Di Mario C, Dudek D, Falk E, Feldman MD, Fitzgerald P, Garcia-Garcia HM, Gonzalo N, Granada JF, Guagliumi G, Holm NR, Honda Y, Ikeno F, Kawasaki M, Kochman J, Koltowski L, Kubo T, Kume T, Kyono H, Lam CC, Lamouche G, Lee DP, Leon MB, Maehara A, Manfrini O, Mintz GS, Mizuno K, Morel MA, Nadkarni S, Okura H, Otake H, Pietrasik A, Prati F, Räber L, Radu MD, Rieber J, Riga M, Rollins A, Rosenberg M, Sirbu V, Serruys PW, Shimada K, Shinke T, Shite J, Siegel E, Sonoda S, Suter M, Takarada S, Tanaka A, Terashima M, Thim T, Uemura S, Ughi GJ, van Beusekom HM, van der Steen AF, van Es GA, van Soest G, Virmani R, Waxman S, Weissman NJ, Weisz G (2012) Consensus standards for acquisition, measurement, and reporting of intravascular optical coherence tomography studies: a report from the International Working Group for Intravascular Optical Coherence Tomography Standardization and Validation. J Am Coll Cardiol 59:1058–1072CrossRefPubMed

14.

Taruya A, Tanaka A, Nishiguchi T, Matsuo Y, Ozaki Y, Kashiwagi M, Shiono Y, Orii M, Yamano T, Ino Y, Hirata K, Kubo T, Akasaka T (2015) Vasa vasorum restructuring in human atherosclerotic plaque vulnerability: a clinical optical coherence tomography study. J Am Coll Cardiol 65:2469–2477CrossRefPubMed

15.

Bryniarski KL, Tahk SJ, Choi SY, Soeda T, Higuma T, Yamamoto E, Xing L, Dai J, Zanchin T, Lee H, Jang IK (2017) Clinical, angiographic, IVUS, and OCT predictors for irregular protrusion after coronary stenting. EuroIntervention 12:e2204–e2211CrossRefPubMed

16.

Sugiyama T, Kimura S, Akiyama D, Hishikari K, Kawaguchi N, Kamiishi T, Hikita H, Takahashi A, Isobe M (2014) Quantitative assessment of tissue prolapse on optical coherence tomography and its relation to underlying plaque morphologies and clinical outcome in patients with elective stent implantation. Int J Cardiol 176:182–190CrossRefPubMed

17.

Dohi T, Maehara A, Moreno PR, Baber U, Kovacic JC, Limaye AM, Ali ZA, Sweeny JM, Mehran R, Dangas GD, Xu K, Sharma SK, Mintz GS, Kini AS (2015) The relationship among extent of lipid-rich plaque, lesion characteristics, and plaque progression/regression in patients with coronary artery disease: a serial nearinfrared spectroscopy and intravascular ultrasound study. Eur Heart J Cardiovasc Imaging 16:81–87CrossRefPubMed

18.

Nasu K, Terashima M, Habara M, Ko E, Ito T, Yokota D, Ishizuka S, Kurita T, Kimura M, Kinoshita Y, Asakura Y, Tsuchikane E, Katoh O, Suzuki T (2013) Impact of cholesterol metabolism on coronary plaque vulnerability of target vessels: a combined analysis of virtual histology intravascular ultrasound and optical coherence tomography. JACC Cardiovasc Interv 6:746–755CrossRefPubMed

19.

Cannon CP, Blazing MA, Giugliano RP, McCagg A, White JA, Theroux P, Darius H, Lewis BS, Ophuis TO, Jukema JW, De Ferrari GM, Ruzyllo W, De Lucca P, Im K, Bohula EA, Reist C, Wiviott SD, Tershakovec AM, Musliner TA, Braunwald E, Califf RM (2015) Ezetimibe added to statin therapy after acute coronary syndromes. N Engl J Med 372:2387–2397CrossRefPubMed

20.

Hong YJ, Jeong MH, Ahn Y, Sim DS, Chung JW, Cho JS, Yoon NS, Yoon HJ, Moon JY, Kim KH, Park HW, Kim JH, Cho JG, Park JC, Kang JC (2008) Plaque prolapse after stent implantation in patients with acute myocardial infarction: an intravascular ultrasound analysis. JACC Cardiovasc Imaging 1:489–497CrossRefPubMed

21.

Hiro T, Kimura T, Morimoto T, Miyauchi K, Nakagawa Y, Yamagishi M, Ozaki Y, Kimura K, Saito S, Yamaguchi T, Daida H, Matsuzaki M (2009) Effect of intensive statin therapy on regression of coronary atherosclerosis in patients with acute coronary syndrome. A multicenter randomized trial evaluated by volumetric intravascular ultrasound using pitavastatin versus atorvastatin (JAPAN-ACS [Japan Assessment of Pitavastatin and Atorvastatin in Acute Coronary Syndrome] Study) Clinical Trials. J Am Coll Cardiol 54:293–302CrossRefPubMed

22.

Komukai K, Kubo T, Kitabata H, Matsuo Y, Ozaki Y, Takarada S, Okumoto Y, Shiono Y, Orii M, Shimamura K, Ueno S, Yamano T, Tanimoto T, Ino Y, Yamaguchi T, Kumiko H, Tanaka A, Imanishi T, Akagi H, Akasaka T (2014) Effect of atorvastatin therapy on fibrous cap thickness in coronary atherosclerotic plaque as assessed by optical coherence tomography: the EASY-FIT study. J Am Coll Cardiol 64:2207–2217CrossRefPubMed

23.

Takano M, Mizuno K, Yokoyama S, Seimiya K, Ishibashi F, Okamatsu K, Uemura R (2003) Changes in coronary plaque color and morphology by lipid-lowering therapy with atorvastatin: serial evaluation by coronary angioscopy. J Am Coll Cardiol 42:680–686CrossRefPubMed

24.

Kim SW, Mintz GS, Ohlmann P, Hassani SE, Fernandez S, Lu L, Chu WW, Escolar E, Kuchulakanti PK, Weigold G, Pichard AD, Satler LF, Kent KM, Suddath WO, Waksman R, Weissman NJ (2006) Frequency and severity of plaque prolapse within Cypher and Taxus stents as determined by sequential intravascular ultrasound analysis. Am J Cardiol 98:1206–1211CrossRefPubMed

25.

Farb A, Sangiorgi G, Carter AJ, Walley VM, Edwards WD, Schwartz RS, Virmani R (1999) Pathology of acute and chronic coronary stenting in humans. Circulation 99:44–52CrossRefPubMed

26.

Katayama T, Kubo N, Takagi Y, Funayama H, Ikeda N, Ishida T, Hirahara T, Sugawara Y, Yasu T, Kawakami M, Saito M (2006) Relation of atherothrombosis burden and volume detected by intravascular ultrasound to angiographic no-reflow phenomenon during stent implantation in patients with acute myocardial infarction. Am J Cardiol 97:301–304CrossRefPubMed

27.

Sato H, Iida H, Tanaka A, Tanaka H, Shimodouzono S, Uchida E, Kawarabayashi T, Yoshikawa J (2004) The decrease of plaque volume during percutaneous coronary intervention has a negative impact on coronary flow in acute myocardial infarction: a major role of percutaneous coronary intervention-induced embolization. J Am Coll Cardiol 44:300–304CrossRefPubMed

28.

Amano H, Koizumi M, Okubo R, Yabe T, Watanabe I, Saito D, Toda M, Ikeda T (2017) Comparison of coronary intimal plaques by optical coherence tomography in arteries with versus without internal running vasa vasorum. Am J Cardiol 119:1512–1517CrossRefPubMed

29.

Virmani R, Burke AP, Farb A, Kolodgie FD (2006) Pathology of the vulnerable plaque. J Am Coll Cardiol 47:C13–18CrossRefPubMed

30.

Virmani R, Kolodgie FD, Burke AP, Finn AV, Gold HK, Tulenko TN, Wrenn SP, Narula J (2005) Atherosclerotic plaque progression and vulnerability to rupture: angiogenesis as a source of intraplaque hemorrhage. Arterioscler Thromb Vasc Biol 25:2054–2061CrossRefPubMed

31.

Kume T, Okura H, Miyamoto Y, Yamada R, Saito K, Tamada T, Koyama T, Neishi Y, Hayashida A, Kawamoto T, Yoshida K (2012) Natural history of stent edge dissection, tissue protrusion and incomplete stent apposition detectable only on optical coherence tomography after stent implantation: preliminary observation. Circ J 76:698–703CrossRefPubMed

32.

Stone GW, Maehara A, Lansky AJ, de Bruyne B, Cristea E, Mintz GS, Mehran R, McPherson J, Farhat N, Marso SP, Parise H, Templin B, White R, Zhang Z, Serruys PW (2011) A prospective natural-history study of coronary atherosclerosis. N Engl J Med 364:226–235CrossRefPubMed

Title: Plaque characteristics and slow flow during percutaneous coronary intervention of irregular protrusion by optical coherence tomography
Authors: Hideo Amano
Ryota Noike
Daiga Saito
Takayuki Yabe
Ippei Watanabe
Ryo Okubo
Masayuki Koizumi
Mikihito Toda
Takanori Ikeda
Publication date: 01-07-2019
Publisher: Springer Japan
Keyword: Myocardial Infarction
Published in: Heart and Vessels / Issue 7/2019
Print ISSN: 0910-8327
Electronic ISSN: 1615-2573
DOI: https://doi.org/10.1007/s00380-018-01335-4

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Plaque characteristics and slow flow during percutaneous coronary intervention of irregular protrusion by optical coherence tomography

Abstract

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 7/2019

Effective blood hemoglobin level to predict prognosis in heart failure with preserved left ventricular ejection fraction: results of the Japanese heart failure syndrome with preserved ejection fraction registry

Percutaneous coronary intervention in patients hospitalized for non-ST-elevation myocardial infarction and the risk of postdischarge ischemic stroke at 6-month, 1-year, and 3-year follow-ups

Relationship between electrical conduction and phasic left atrial function: P-wave signal-averaged electrocardiography and time-left atrial volume curve assessments using two-dimensional speckle-tracking echocardiography

Prognostic value of echocardiographic parameters for right ventricular function in patients with acute non-massive pulmonary embolism

Coronary computed tomography angiography as a tool for long-term cardiovascular risk stratification in diabetic patients

Increase of chymase-dependent angiotensin II-forming activity in circulating mononuclear leukocytes after acute myocardial infarction chymase activity after acute myocardial infarction

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page