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Lookup NU author(s): Dr Mohaned Egred, Dr Javed Ahmed
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
Copyright © 2022 Jin, Torii, Ramasamy, Tufaro, Little, Konstantinou, Tan, Yap, Cooper, Crake, O’Mahony, Rakhit, Egred, Ahmed, Karamasis, Räber, Baumbach, Mathur and Bourantas.Background: Intravascular imaging has been used to assess the morphology of lesions causing an acute coronary syndrome (ACS) in native vessels (NV) and identify differences between plaques that ruptured (PR) and caused an event and those that ruptured without clinical manifestations. However, there is no data about the morphological and physiological characteristics of neoatherosclerotic plaques that ruptured (PR-NA) which constitute a common cause of stent failure. Methods: We retrospectively analyzed data from patients admitted with an acute myocardial infarction that had optical coherence tomography (OCT) imaging of the culprit vessel before balloon pre-dilation. OCT pullbacks showing PR were segmented at every 0.4 mm. The extent of the formed cavity, lipid and calcific tissue, thrombus, and macrophages were measured, and the fibrous cap thickness (FCT) and the incidence of micro-channels and cholesterol crystals were reported. These data were used to reconstruct a representative model of the native and neoatherosclerotic lesion geometry that was processed with computational fluid dynamics (CFD) techniques to estimate the distribution of the endothelial shear stress and plaque structural stress. Result: Eighty patients were included in the present analysis: 56 had PR in NV (PR-NV group) and 24 in NA segments (PR-NA group). The PR-NV group had a larger minimum lumen area (2.93 ± 2.03 vs. 2.00 ± 1.26 mm2, p = 0.015) but similar lesion length and area stenosis compared to PR-NA group. The mean FCT (186 ± 65 vs. 232 ± 80 μm, p = 0.009) and the lipid index was smaller (16.7 ± 13.8 vs. 25.9 ± 14.1, p = 0.008) while the of calcific index (8.3 ± 9.5 vs. 2.2 ± 1.6%, p = 0.002) and the incidence of micro-channels (41.4 vs. 12.5%, p = 0.013) was higher in the PR-NV group. Conversely, there was no difference in the incidence of cholesterol crystals, thrombus burden or the location of the rupture site between groups. CFD analysis revealed higher maximum endothelial shear stress (19.1 vs. 11.0 Pa) and lower maximum plaque structural stress (38.8 vs. 95.1 kPa) in the PR-NA compared to the PR-NV model. Conclusion: We reported significant morphological and physiological differences between culprit ruptured plaques in native and stented segments. Further research is needed to better understand the causes of these differences and the mechanisms regulating neoatherosclerotic lesion destabilization.
Author(s): Jin C, Torii R, Ramasamy A, Tufaro V, Little CD, Konstantinou K, Tan YY, Yap NAL, Cooper J, Crake T, O'Mahony C, Rakhit R, Egred M, Ahmed J, Karamasis G, Raber L, Baumbach A, Mathur A, Bourantas CV
Publication type: Article
Publication status: Published
Journal: Frontiers in Cardiovascular Medicine
Year: 2022
Volume: 9
Online publication date: 26/05/2022
Acceptance date: 04/05/2022
Date deposited: 03/07/2023
ISSN (electronic): 2297-055X
Publisher: Frontiers Media S.A.
URL: https://doi.org/10.3389/fcvm.2022.890799
DOI: 10.3389/fcvm.2022.890799
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