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Plaque disruption and thrombus in Ambrose's angiographic coronary lesion types
Sergio Waxman1, Murray A Mittleman, Stuart W Zarich
1Division of Cardiology, New England Medical Center and Tufts University School of Medicine, Boston, Massachusetts 02111, USA. swaxman@tufts-nemc.org
Insights
Eccentric coronary lesions identified by angiography, particularly Ambrose type II, strongly predict disrupted plaques and thrombus. This finding aids in identifying unstable atherosclerotic plaques in vivo.
Area of Science:
- Cardiology
- Interventional Cardiology
- Atherosclerosis Research
Background:
- Coronary angiography showing lesion eccentricity and irregularities is linked to ruptured plaques and thrombus.
- The in vivo predictive value of these angiographic markers for plaque disruption and thrombus requires further determination.
Purpose of the Study:
- To ascertain if Ambrose's coronary lesion types and other angiographic criteria predict disrupted plaques and thrombus using intracoronary angioscopy.
- To evaluate the diagnostic accuracy of specific angiographic features for identifying complicated atherosclerotic plaques.
Main Methods:
- Intracoronary angioscopy was performed in 60 patients with non-totally occlusive culprit lesions before angioplasty.
- Lesions were angiographically classified using Ambrose's criteria (concentric, type I/II eccentric, multiple irregularities) and as complex/noncomplex.
- Angioscopic findings were compared with angiographic classifications to assess plaque disruption and thrombus presence.
Main Results:
- Ambrose type II eccentric lesions showed a positive predictive value of 89% for detecting disrupted plaques and/or thrombus.
- Angiographically complex lesions demonstrated a 91% positive predictive value for identifying disrupted plaques and/or thrombus.
- Disruption and/or thrombus were observed in 17/19 type II eccentric lesions and 21/23 complex lesions.
Conclusions:
- Ambrose's type II eccentric stenoses are strongly associated with disrupted plaques and/or thrombus.
- Angiographically complex coronary lesions are indicative of unstable plaque substrates.
- Angioscopy confirms the association between specific angiographic features and complicated atherosclerotic plaques in vivo.
Abstract:
Lesion eccentricity with irregularities on coronary angiography is associated with ruptured plaques and thrombus based on postmortem and clinical angiographic studies. However, the predictive value of such angiographic markers of plaque disruption and thrombus remains to be determined in vivo. The purpose of this study was to establish whether Ambrose's angiographic coronary lesion types and other angiographic criteria predict the presence of disrupted plaques and thrombus using intracoronary angioscopy. Angioscopy was performed before angioplasty in 60 patients with various coronary syndromes and culprit lesions that were not totally occlusive. Lesions were classified angiographically according to Ambrose's criteria as concentric, type I and II eccentric, and multiple irregularities, or as complex or noncomplex, and then compared with the corresponding angioscopic findings. Disruption and/or thrombus were seen in 17 of 19 type II eccentric lesions and 21 of 23 angiographically complex lesions and had the highest positive predictive value to detect complicated atherosclerotic plaques (type II eccentric lesions: positive predictive value 89%, 95% confidence intervals 67% to 99%; complex lesions: 91%, 95% confidence intervals 72% to 99%). We conclude that Ambrose's type II eccentric stenoses and angiographically complex lesions are strongly associated with disrupted plaques and/or thrombus as assessed by angioscopy in patients and represent unstable plaque substrates.