Combined Use of Multiple Intravascular Imaging Techniques in Acute Coronary Syndrome.

Takashi Kubo,Tien-Ping Tsao,Shengxian Tu,Duk-Woo Park,Yasutsugu Shiono,Yasushi Ino,Yundai Chen,Kosei Terada

doi:10.3389/fcvm.2021.824128

Abstract

Recent advances in intravascular imaging techniques have made it possible to assess the culprit lesions of acute coronary syndrome (ACS) in the clinical setting. Intravascular ultrasound (IVUS) is the most commonly used intravascular imaging technique that provides cross-sectional images of coronary arteries. IVUS can assess plaque burden and vessel remodeling. Optical coherence tomography (OCT) is a high-resolution (10 μm) intravascular imaging technique that uses near-infrared light. OCT can identify key features of atheroma, such as lipid core and thin fibrous cap. Near-infrared spectroscopy (NIRS) can detect lipid composition by analyzing the near-infrared absorption properties of coronary plaques. NIRS provides a chemogram of the coronary artery wall, which allows for specific quantification of lipid accumulation. These intravascular imaging techniques can depict histological features of plaque rupture, plaque erosion, and calcified nodule in ACS culprit lesions. However, no single imaging technique is perfect and each has its respective strengths and limitations. In this review, we summarize the implications of combined use of multiple intravascular imaging techniques to assess the pathology of ACS and guide lesion-specific treatment.

Highlights

Several autopsy studies have revealed the pathology of culprit lesions of acute coronary syndrome (ACS)
Near-infrared spectroscopy (NIRS) provides a chemogram of the coronary artery wall, which enables the detection of lipid core and specific quantification of lipid accumulation measured as the lipid core burden index (LCBI) and maximal LCBI over any 4 mm segment
A prospective observational Optical coherence tomography (OCT) study demonstrated that a majority (92.5%) of patients with ACS caused by plaque erosion managed with dual antiplatelet therapy without stenting remained free of major adverse cardiovascular event during 1-year follow-up period [20]

Summary

INTRODUCTION

Several autopsy studies have revealed the pathology of culprit lesions of acute coronary syndrome (ACS). In the late 2000s, near-infrared spectroscopy (NIRS) was clinically applied, which permits to diagnose plaque composition These intravascular imaging techniques can depict histological features of plaque rupture, plaque erosion, and calcified nodule in ACS culprit lesions [2]. Convex calcium, and maxLCBI4mm, NIRS-IVUS can accurately identify plaque rupture (sensitivity = 97% and specificity = 96%), plaque erosion (sensitivity = 93% and specificity = 99%), and calcified nodule (sensitivity = 100% and specificity = 99%) [13]. Plaque rupture is identified by fibrous cap disruption and intra-plaque cavity in IVUS/OCT, attenuated plaque in IVUS, large lipid plaque in OCT, and high maxLCBI4mm (>400) in NIRS (Figure 1-I). Calcified nodule is identified by convex calcium and large calcium sheet in IVUS/OCT, and intermediate maxLCBI4mm in NIRS (Figure 1-III). Further research is needed to evaluate the effectiveness of more aggressive procedures such as rotational atherectomy, excimer laser coronary angioplasty, and shockwave intravascular lithotripsy for calcified nodules

LIMITATIONS

Findings

CONCLUSION