Author + information
- Junji Mastuda,
- Taishi Yonetsu,
- Tadashi Murai,
- Yoshihisa Kanaji,
- Eisuke Usui,
- Makoto Araki,
- Takayuki Niida,
- Rikuta Hamaya and
- Tsunekazu Kakuta
Background: Optical Coherence Tomography (OCT) studies have described unstable morphological characteristics of lesions of in-stent restenosis including neoatherosclerosis. Coronary angioscopy (CAS) provides direct visualizations of coronary luminal surface. Few reports that compared findings of instent restenotic lesions between angioscopic and OCT assessment have been published. We sought to evaluate the concordant and discordant findings obtained by both modalities.
Methods: From the institutional OCT and CAS database, 43 patients with ACS and stable angina (ACS 7, SAP 36) who underwent pre-PCI both OCT and CAS examinations and were subsequently treated by PCI were evaluated.
Results: On CAS findings, numbers of the lesions showing color grade of intensive yellow, yellow, light yellow, and white were 12, 6, 16, 9, respectively. Thrombus were detected in 13/43(30.2%), and ruptured plaque were found in 12/43(28%). On OCT, lipid plaque was found in 21/43(48.8%), thrombus in 9/43(21%), ruptured plaque in 9/43(21%), calcification in 5/43(11.6%), macropharge imaging in 15/43(34.9%), respectively. Median minimum lumen area (MLA) was 1.34mm2 (0.96 −1.73), and mean thinnest fibrous cap thickness was 100μm (79 −121). OCT-defined lipid plaques showed CAS color grade ≥2 in 14/21 (66.7%) and 18 out of 22 (81.8%) non lipid plaques defined by OCT presented CAS grade < 2. Seven out of 9 OCT-defined thrombotic lesions also had thrombus in CAS findings. Thrombus detection was superior in CAS compared to OCT. In 9 OCT-defined ruptured plaques, CAS detected 7 (77.8%) lesions. Eighteen OCT-defined non-lipid plaques showed 2 intensive yellow plaques, 2 yellow plaques, 12 light yellow, 6 white plaques, and 4 thrombus, and 2 ruptured plaques in CAS findings.
Conclusions: OCT-derived neoatherosclerosis showed relatively unstable features on CAS findings, while CAS-derived yellow neointima did not necessarily agree with OCT-derived neoatherosclerosis. OCT analysis may underestimate instability of instent restenotic lesions, particularly in OCT-defined non-lipid rich plaques. Further investigation is warranted for better understanding of neointima and its potential link with outcomes.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Unusual Presentations of ACS
Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical
Presentation Number: 1297-344
- 2017 American College of Cardiology Foundation