High-risk plaque features and perivascular inflammation.

Area of Science:

• Cardiovascular Imaging
• Interventional Cardiology
• Radiology

Background:

• The relationship between high-risk plaque (HRP) features on coronary computed tomography angiography (CTA) and perivascular inflammation requires further investigation.
• Perivascular inflammation is increasingly recognized as a factor in atherosclerotic plaque development and instability.

Purpose of the Study:

• To investigate the association between specific HRP features identified by CTA and the degree of perivascular inflammation.
• To determine if positive remodeling (PR) is independently associated with perivascular inflammation.

Main Methods:

• Patients undergoing both CTA and optical coherence tomography (OCT) were analyzed.
• Pericoronary adipose tissue (PCAT) attenuation was measured to quantify perivascular inflammation.
• HRP features including positive remodeling (PR), low-attenuation plaque (LAP), napkin-ring sign (NRS), and spotty calcification (SC) were assessed.

Main Results:

• Lesion-specific PCAT attenuation was significantly higher in lesions with PR, LAP, and NRS compared to those without.
• After adjusting for confounders, only PR remained significantly associated with higher lesion-specific PCAT attenuation.
• The number of lesions with PR correlated with the level of perivascular inflammation and was associated with higher lipid index and macrophage grade.

Conclusions:

• Positive remodeling (PR) is the primary HRP feature associated with increased lesion-specific perivascular inflammation.
• The extent of PR in coronary plaques correlates with the degree of perivascular inflammation and plaque vulnerability.