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Angioscopic evaluation of atherosclerotic plaques: validation by histomorphologic analysis and association with
T Thieme1, K D Wernecke, R Meyer
1Medizinische Klinik and Poliklinik I, Arbeitsgruppe für Medizinische Biometric, Medizinische Fakultät der Humboldt-Universität, Berlin, Germany.
Insights
Coronary angioscopy findings were validated with atherectomy histology. Yellow plaque color indicates degenerated plaque or atheroma, linked to unstable coronary syndromes.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Histopathology
Background:
- Coronary angioscopy provides visual assessment of coronary artery lesions.
- Previous angioscopic classifications lacked histomorphologic validation.
- Clinical significance of angioscopic findings requires substantiation.
Purpose of the Study:
- To validate coronary angioscopic observations using histologic assessment of atherectomy specimens.
- To establish a histomorphologic basis for interpreting angioscopic findings.
- To correlate angioscopic lesion appearance with coronary syndrome type.
Main Methods:
- Coronary angioscopy performed in 63 patients with stable or unstable angina.
- Atherectomy specimens analyzed histologically and compared with ex vivo angioscopic visualization.
- Comparison of angioscopic and histologic findings in 44 patients.
Main Results:
- Yellow lesions were predominant in unstable angina (89%) versus stable angina (57%).
- Ruptured plaques and thrombi were more frequent in unstable angina (39%) than stable angina (11%).
- Histology confirmed yellow lesions correlate with degenerated plaque or atheroma.
Conclusions:
- Histomorphologic validation supports classification of angioscopic findings.
- Yellow plaque color is a reliable indicator of degenerated plaque/atheroma.
- Yellow lesions are associated with unstable coronary syndromes.
Objectives:
We validated coronary angioscopic observations with histologic assessment of material removed by atherectomy.
Background:
Up to now, angioscopic findings have been primarily descriptive, and the clinical significance still needs to be substantiated. The proposed Ermenoville classification is relevant but has not yet been validated by histomorphologic analysis.
Methods:
We compared angioscopic findings in patients with different coronary syndromes and used atherosclerotic material retrieved by directional coronary atherectomy to validate the angioscopic observations. Coronary angioscopy was performed in 63 patients (56 men, 7 women) with stable (26 patients) and unstable angina (37 patients) before and after directional coronary atherectomy. The identity of atherectomized material was confirmed by ex vivo visualization with the angioscope and by postatherectomy angioscopy. Angioscopic and histologic findings could be compared in 44 of 63 patients.
Results:
Angioscopic findings were grouped into gray-white and yellow lesions (gray-yellow, deep yellow, yellow-red or yellow-pink). We found that patients with unstable angina had predominantly yellow lesions (89%). In patients with stable angina, gray-white (43%) or yellow (57%) lesions were similarly distributed. Ruptured yellow plaques and red or pink thrombi were identified in 11% of patients with stable angina and 39% of patients with unstable or early postmyocardial infarction angina. Histologically, gray-white lesions represented fibrous plaque without degeneration in 64% and with degeneration in 36% of patients. Gray-yellow lesions were associated predominantly with degenerated plaque (64%) and, to a lesser extent, with fibrous plaque (14%) or atheroma (14%). Deep yellow and yellow-red lesions represented either atheroma (53%) or degenerated plaque (42%).
Conclusions:
Our study establishes a histomorphologic basis for classification and interpretation of angioscopic findings. Yellow plaque color is closely related to degenerated plaque or atheroma and is associated with unstable coronary syndromes.