Author + information
- Received January 27, 1992
- Revision received July 9, 1992
- Accepted July 13, 1992
- Published online January 1, 1993.
- John McB. Hodgson, MD, FACC∗,
- Karan G. Reddy, MD1,
- Randeep Suneja, MD,
- Ravi N. Nair, MD,
- Edward J. Lesnefsky, MD, FACC and
- Helen M. Sheehan, RN
- ↵∗Address for correspondence: John McB. Hodgson, MD, Division of Cardiology, University Hospitals of Cleveland, 2074 Abington Road, Cleveland, Ohio 44106.
Objectives. This study was designed to establish the relation between ultrasound-derived atheroma morphology and the clinical, procedural and angiographie features of patients presenting for coronary angioplasty.
Background. Intracoronary ultrasound imaging provides accurate dimensional information regarding arterial lumen and wall structures. Atheroma composition may also be assessed by ultrasound; however, only limited studies have been performed in patients.
Methods. In 65 patients a diagnostic ultrasound imaging catheter or a combination imaging-angioplasty balloon catheter was used during coronary angioplasty to image both the lesion and the vessel segment just proximal to it (reference segment). Ultrasound images were analyzed for lumen, total vessel and plaque areas and were classified into five morphologic subtypes (soft, fibrous, calcific, mixed plaque and concentric subintimal thickening). These data were compared with angiographic morphologic features, procedural results and clinical angina pattern (stable vs. unstable).
Results. Morphologic analysis of the ultrasound images obtained from the lesion correlated well with the clinical angina syndrome. Compared with patients with stable angina, patients with unstable angina had more soft lesions (74% vs. 41%), fewer calcified and mixed plaques (fibrotic, soft or calcific contponeats in one or more combinations [25% vs. 59%]) and fewer intralesional calcium deposits (16% vs. 45%) (all p < 0.01). There was no correlation between ultrasound and angiographic lesion morphologic characteristics for either the reference segment or the lesion. Ultrasound demonstrated greater sensitivity than angiography for identifying unstable lesions (74% vs. 40%). Dimensional analysis demonstrated a large plaque burden in the reference segments 145 ± 15% of total vessel area). Postangioplasty plaque burden was also high (62 ± 9%). There was a significant, but only fair correlation between lumen area determined by angiography and ultrasound for both the reference segment (r = 0.70, p < 0.001) and the postangioplasty lesion (r = 0.63, p < 0.05).
Conclusions. Morphologic plaque classification by ultrasound is closely correlated to clinical angina but has little relation to established angiographie morphologic characteristics, Iatracoronary ultrasound imaging daring angioplasty identifies a large residual plaque burden in both the reference segment and the lesion. In the future, determination of plaque composition by intracoronary ultrasound may be important in selecting or modifying interventional therapeutic options.
↵1 Dr. Reddy was supported by a fellowship award from the American Heart Association, Northeast Ohio Affiliate., Cleveland.
☆ Additional financial support was provided by Endosonics Corporation, Pleasanton, California.
- Received January 27, 1992.
- Revision received July 9, 1992.
- Accepted July 13, 1992.