Morphologic Features of Carotid Plaque Rupture Assessed by Optical Coherence Tomography.

Area of Science:

• Vascular biology
• Medical imaging
• Cardiovascular research

Background:

• Plaque rupture and thrombosis are primary causes of stroke.
• Understanding the morphology of plaque rupture is crucial for stroke prevention.

Purpose of the Study:

• To evaluate the morphologic features of plaque rupture in carotid arteries.
• To identify key indicators of plaque rupture using in vivo optical coherence tomography.

Main Methods:

• Prospective imaging of 36 carotid plaques with high-grade stenosis using optical coherence tomography (OCT).
• Definition of "plaque rupture" as a plaque with a cavity and overlying residual fibrous caps.
• Measurement of fibrous cap thickness and distance to the bifurcation point.

Main Results:

• OCT identified 24 ruptured and 12 nonruptured plaques.
• Most ruptures (84%) occurred at the plaque shoulder near the bifurcation (within 4.2 mm).
• A fibrous cap thickness <130 μm was identified as the critical threshold for plaque rupture, with a median of 80 μm in ruptured plaques.

Conclusions:

• Plaque rupture is frequent in carotid arteries with high-grade stenosis.
• Ruptures are typically located at the plaque shoulder near the bifurcation.
• Fibrous cap thickness <130 μm is a significant threshold for carotid artery plaque rupture.