Abstract 21553: Minimal Lumen Site is Not Involved in the Rupture Site of Culprit Lesions in the Majority of Patients With Acute Coronary Syndrome. An Optical Coherence Tomography Study.
Purpose: There are only a limited number of in vivo studies which describe the morphological characteristics of the several parts of culprit lesions in patients (pts) with ACS. As optical coherence tomography (OCT) has a high sensitivity for plaque rupture detection and a high resolution for detection and quantification of plaque components, we studied rupture site morphological characteristics in relation to the characteristics of minimal lumen site of culprit lesion in patients (pts) with ACS, using OCT.
Methods: We studied 42 pts with ACS, where rupture of culprit lesion (CL) could be detected with OCT study. Plaque rupture was defined as presence of intimal tearing, disruption, or dissection of the fibrous cap with a cavity formation. CL was identified by a combination of ECG, transthoracic echocardiogram and coronary angiography. Optical coherence tomography image acquisition was performed in CL, before any balloon dilatation or stent deployment.
Results: We studied 42 pts with ACS where rupture of the CL could be identified by OCT. In 35.7% (n=15) of the study population plaque was ruptured at the site of minimal lumen versus 64.2% (n=27) of pts whose minimal lumen site located away from rupture site (p<0.01). In 54.7% (n=23) of pts, plaque rupture was located distally to minimal lumen site, while in 42.8% (n=18) of pts plaque rupture was located proximally to minimal lumen site (p=ns). Mean length of rupture was 2.27±1.7mm and mean distance from the site of greatest stenosis was 2.34±2.4mm. Mean cross sectional area (CSA) of the site of rupture was 4.18±2.59mm2, while mean CSA of minimal lumen site was 1.97±1.64mm2 (p<0.01). Mean fibrous cap thickness (FCT) at the site of plaque rupture was 59±21μm versus 95.8±48.7μm at minimal lumen site (p<0.001).
Conclusions: Although fibrous cap thickness is lower at the site of plaque rupture compared to minimal lumen site, in the majority of culprit lesions of pts with ACS minimal lumen site is not involved in rupture site. Larger in vivo studies are needed to study this finding for making the identical choice for stenting the culprit ruptured plaque of pts with ACS.
- © 2010 by American Heart Association, Inc.