[Intravascular ultrasound for recognition of atherosclerotic plaques and plaque composition. Current state of the
1Abteilung Kardiologie, Medizinische Klinik und Poliklinik-Campus Innenstadt, Ludwig-Maximilians-Universität, Ziemssenstrasse 1, Munich, Germany. Andreas.Koenig@med.uni-muenchen.de
Insights
Intravascular ultrasound (IVUS) with radiofrequency (RF) data improves plaque analysis for coronary artery disease. While IVUS-RF can identify high-risk lesions, current evidence does not support invasive treatment for non-flow-limiting plaques.
Area of Science:
- Cardiology
- Medical Imaging
- Interventional Cardiology
Background:
- Coronary atherosclerosis, including acute coronary syndrome (ACS), is a leading cause of mortality.
- Plaque rupture in coronary lesions, even non-flow-limiting ones, is a primary cause of ACS.
- Traditional angiography and clinical parameters inadequately predict future cardiovascular events.
Purpose of the Study:
- To evaluate the role of intravascular ultrasound (IVUS) and its radiofrequency (RF) data analysis in characterizing coronary plaque composition and vulnerability.
- To assess the utility of IVUS in guiding percutaneous coronary interventions (PCI) and stratifying patient risk.
- To determine if IVUS-RF imaging can identify high-risk, non-flow-limiting lesions prone to rupture.
Main Methods:
- Utilized intravascular ultrasound (IVUS) for in vivo plaque imaging, assessing discrepancies with angiographic findings.
- Employed spectral analysis of IVUS-derived radiofrequency (RF) data for detailed plaque composition and type analysis.
- Reviewed prospective studies investigating IVUS-RF imaging for the detection of rupture-prone lesions.
Main Results:
- IVUS provides superior imaging of coronary atherosclerosis compared to angiography, revealing plaque details.
- IVUS-RF spectral analysis offers precise characterization of plaque composition and vulnerability.
- Prospective studies found no benefit in invasive treatment for non-flow-limiting high-risk plaques identified by IVUS-RF.
Conclusions:
- IVUS, particularly with RF analysis, enhances the assessment of coronary plaque characteristics and lesion vulnerability.
- IVUS plays a crucial role in guiding PCI and optimizing patient stratification, especially in complex lesions.
- Future research integrating multiple imaging modalities like IVUS-RF and optical coherence tomography may further refine the detection and management of high-risk coronary lesions.
Abstract:
Coronary atherosclerosis including acute coronary syndrome (ACS) is the leading cause of death in the western world and in the majority of patients is caused by plaque rupture in flow-limiting and non-flow-limiting angiographically intermediate stenoses. Histopathologic analyses have shown the relationship of plaque composition to acute clinical events and therefore to the vulnerability of coronary lesions. Knowledge of remodeling processes of the coronary artery has focused interest on non-flow-limiting lesions of the coronary tree. Intravascular ultrasound (IVUS) can demonstrate discrepancies between the extent of coronary atherosclerosis and angiographic imaging by in vivo plaque imaging. In addition the spectral analysis of IVUS-derived radiofrequency (RF) data enables more precise analysis of the plaque composition and plaque type.As IVUS is best able to assess stent underexpansion and malapposition the guidance of catheter-based coronary interventions plays a major role in angiographically unclear lesions even in the drug-eluting stent era. In the field of percutaneous coronary interventions (PCI) IVUS can influence the therapy and therefore optimize the stratification of patients.In terms of secondary prevention it is of great clinical importance to detect progression of coronary artery disease and moreover to predict coronary lesions with significant progression up to ACS. Coronary angiography and clinical parameters are poor surrogates to predict future events in a broad cohort of patients after PCI. In addition non-invasive imaging fails to identify coronary plaques with potential rupture and subsequent ACS. This highlights the need to identify potentially high risk lesions. However, prospective studies with IVUS-RF imaging to detect lesions that are considered to be prone to rupture showed no evidence for catheter-based invasive treatment of a non-flow-limiting high risk plaque.In the future the integrated combination of multiple technologies (e.g. IVUS-RF and optical coherence tomography) can further improve the accuracy of the analysis of high risk lesions.
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