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Updated: Jan 13, 2026

Quantitative Analysis and Characterization of Atherosclerotic Lesions in the Murine Aortic Sinus
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Functional and morphological characterization of coronary atherosclerosis

Koshiro Sakai1, Toshiro Shinke2, Ziad Ali3

  • 1Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Department of Medicine, Division of Cardiology, Showa University School of Medicine, Tokyo, Japan; Department of Cardiology, St Francis Hospital and Heart Center, Roslyn, NY, USA.

Atherosclerosis
|January 7, 2026
PubMed

Insights

The Pullback Pressure Gradient (PPG) correlates with plaque burden in coronary artery disease (CAD). High PPG, indicating focal disease, is linked to greater plaque and lipid-rich plaques, while low PPG (diffuse disease) shows more calcified plaques.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Medical Imaging

Background:

  • Coronary artery hemodynamics and atherosclerotic plaque interplay is not fully understood.
  • Pullback Pressure Gradient (PPG) is a novel metric for categorizing coronary artery disease (CAD) into focal or diffuse patterns.
  • Understanding these patterns is crucial for effective percutaneous coronary intervention (PCI).

Purpose of the Study:

  • To investigate the association between PPG and coronary atherosclerosis.
  • To characterize coronary atherosclerosis using intravascular ultrasound (IVUS) in conjunction with PPG.
  • To determine if PPG can predict plaque characteristics in hemodynamically significant lesions.

Main Methods:

  • A pre-specified analysis of the PPG Global study (NCT04789317) was conducted.
  • Stable patients with hemodynamically significant lesions (FFR ≤0.80) undergoing IVUS-guided PCI were included.
  • PPG was calculated from manual FFR pullbacks, and CAD patterns were classified as focal or diffuse based on median PPG (0.62).

Main Results:

  • A significant correlation (r=0.53, p<0.001) was found between PPG and plaque burden in 261 patients.
  • Focal CAD (high PPG) showed higher plaque burden (83±6%) than diffuse CAD (76±8%, p<0.001).
  • Attenuated plaques were more prevalent with high PPG (68% vs. 39%, p<0.001), while calcified plaques were more frequent with low PPG (60% vs. 78%, p=0.003).

Conclusions:

  • High PPG in flow-limiting stenoses is associated with increased plaque burden.
  • Focal disease (high PPG) is characterized by lipid-rich plaques.
  • Diffuse disease (low PPG) is associated with a greater calcium burden.
Abstract

Keywords:
Atheroma plaque volumeIntravascular ultrasoundMinimal lumen areaPlaque burdenPullback pressure gradientWire-based physiology

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