Plaque vulnerability and thrombus formation according to area stenosis in chronic stable angina

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Medical Imaging

Background:

• Chronic stable angina (CSA) management requires understanding plaque vulnerability.
• The link between stenosis severity and plaque characteristics in CSA is not fully elucidated.
• Optical coherence tomography (OCT) offers detailed insights into coronary plaque morphology.

Purpose of the Study:

• To investigate the relationship between luminal stenosis severity and plaque vulnerability in CSA patients.
• To assess the prevalence of thrombus and specific plaque characteristics across different stenosis severity groups.
• To identify independent predictors of thrombus formation in CSA.

Main Methods:

• A retrospective analysis of 174 lesions in 146 CSA patients undergoing OCT.
• Lesions were categorized into three groups based on area stenosis (AS): <50%, 50-70%, and ≥70%.
• Plaque characteristics including thrombus, lipid-rich plaque, thin-cap fibroatheroma, and ruptured plaque were analyzed.

Main Results:

• Thrombus prevalence was 19.0% and significantly increased with stenosis severity (0% in <50% AS, 17.6% in 50-70% AS, 24.2% in ≥70% AS).
• Higher area stenosis was associated with increased prevalence of lipid-rich plaque, thin-cap plaque, macrophage infiltration, and ruptured plaque.
• Multivariate analysis identified ruptured plaque, macrophage infiltration, lipid angle, and area stenosis as independent predictors of thrombus.

Conclusions:

• Thrombus is not uncommon in CSA patients as assessed by OCT.
• Plaque vulnerability, including thrombus, escalates with increasing area stenosis severity.
• The minimal lumen site, subject to high shear stress, showed a higher prevalence of thrombus.