Abstract
Objectives: Recently, several case reports using intravascular ultrasound (IVUS) have demonstrated peri-vascular abnormal mass (PVAM) or tumorous lesions of the coronary artery as coronary periarteritis in patients with IgG4-related disease. The aim of this study was to clarify the frequency and characteristics of PVAM in human coronary arteries. Methods: We reviewed 655 coronary vessels in 481 patients who underwent PCI for de novo coronary artery lesions using IVUS from January 1, 2017, to June 30, 2020. PVAM was defined as low echoic abnormal structures with or without high echoic areas that surround the coronary arteries (exterior to media) in a crescentic or circumferential fashion. In addition to standard gray scale IVUS observation, radiofrequency derived tissue characterization of the PVAM was performed to identify tissue characteristics using integrated backscatter IVUS (IB-IVUS). Results: PVAM were identified in 4 of 481 patients (0.83%) and 5 of 655 vessels (0.76%), respectively. Mean age was 64 years and 3 were male. Clinical presentation was chronic coronary syndrome in 3 patients and acute coronary syndrome in 1 patient. Mean length of the PVAM was 33 mm (SD 16mm) and the arc was 360°, respectively. The IB-IVUS analysis of the PVAM showed that the lesion had a mixed green, blue and purple color-coded layer (figure), indicating the tissue characteristics similar to those of fibrous plaque and lipid pool. Conclusions: Coronary periarteritis was a relatively rare (<1%) finding in patients with coronary artery disease who underwent PCI. Further study with larger sample size is needed to clarify prognostic impact of the coronary periarteritis.
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