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Association between carotid and coronary atherosclerotic plaque morphology: a virtual histology intravascular
Dace Sondore1, Kārlis Trušinskis1,2, Matīss Linde2
1Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, Riga, Latvia.
Insights
Atherosclerotic plaque composition moderately correlates between carotid and coronary arteries. Patients with prior cerebrovascular events showed a trend toward higher necrotic core content in carotid plaques.
Area of Science:
- Cardiovascular Medicine
- Medical Imaging
- Vascular Biology
Background:
- Atherosclerosis is a systemic disease with heterogeneous manifestations in different arterial beds.
- Understanding morphological differences between carotid and coronary artery disease is crucial for risk stratification.
- Virtual histology intravascular ultrasound (VH-IVUS) enables detailed plaque characterization.
Purpose of the Study:
- To evaluate the relationship of plaque morphology between carotid and coronary arteries using VH-IVUS.
- To compare plaque composition in patients with and without a history of cerebrovascular events.
Main Methods:
- Prospective, single-center study of 100 patients undergoing carotid or coronary artery stenting.
- VH-IVUS examination of both carotid and coronary arteries prior to intervention.
Main Results:
- Moderate correlations (r=0.38-0.56) were found for necrotic core, fibrofatty, dense calcium, and fibrous components between carotid and coronary plaques.
- Coronary arteries had a higher proportion of necrotic core (22.7% ± 6.8%) compared to carotid arteries (20.2% ± 9.4%).
- Carotid plaques showed a higher proportion of fibrolipid content (19.6% ± 9.9%) than coronary plaques (12.2% ± 8.1%).
- Patients with a history of cerebrovascular events tended to have a greater proportion of necrotic tissue in carotid plaques (23.5% ± 10.7%).
Conclusions:
- Plaque composition is moderately correlated between carotid and coronary arteries, but distinct differences exist.
- Coronary arteries show more necrotic core, while carotid arteries exhibit more fibrolipid content.
- A history of cerebrovascular events may be associated with a higher necrotic core content in carotid artery plaques, indicating potential high-risk features.
Background And Aim:
Atherosclerosis is considered to be a systemic disease; however, evidence exists on the heterogeneous nature of atherosclerotic disease. To date, continuous research seeks to determine the morphological differences between carotid and coronary artery disease. This study aimed to evaluate the relationship of morphological characteristics assessed by virtual histology intravascular ultrasound (VH-IVUS) between carotid and coronary plaque composition among patients with and without a history of cerebrovascular events.
Methods:
This study was a single-center prospective study (n = 100; age 69.6 ± 8.4). All patients were scheduled for carotid or coronary artery stenting and underwent VH-IVUS examination of the carotid and coronary arteries before intervention.
Results:
There was a modest, but statistically significant correlation between the carotid and coronary necrotic core ([NC] r = 0.46, P < 0.01), fibrofatty ([FF] r = 0.38, P < 0.01), dense calcium (r = 0.56, P < 0.01), and fibrous (r = 0.42, P < 0.01) plaque composition. The high amount of NC was detected in both arteries of the carotid artery stenting (CAS) group with higher proportion in the coronary artery (20.2% ± 9.4 % vs. 22.7% ± 6.8%, P = 0.02). More fibrolipid content was observed in carotid plaque compared to coronary (19.6% ± 9.9% vs. 12.2% ± 8.1%, P < 0.01). Patients with a history of cerebrovascular events had a numerically greater proportion of necrotic tissue in the carotid artery compared to asymptomatic and symptomatic CAS group patients (23.5% ± 10.7% vs. 18.9% ± 8.2% and 18.7% ± 9.5%, P = 0.11).
Conclusion:
The percentage of all analyzed plaque components was moderately correlated between coronary and carotid artery plaques. Nevertheless, the proportion of NC plaque tissue was greater in the coronary arteries, while the carotid arteries showed more %FF atherosclerotic lesions. CAS group patients with a history of cerebrovascular events had a tendency of greater proportion of necrotic tissue in analyzed carotid plaques compared to others in the CAS group.
Relevance For Patients:
In this study, we found that patients with a history of cerebrovascular event had a tendency of increased NC content in culprit lesion of carotid artery. Complementary use of non-invasive and invasive imaging modalities allows to detect high-risk atherosclerotic plaques and adjust treatment strategy.
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