Characteristics Of Lesions In Patients Research Articles

P4596Long-term outcomes of culprit lesion only versus multi-vessel one-stage intervention in non-ST elevation acute coronary syndrome patients undergoing percutaneous coronary interventioo

Abstract Background It is recommended to base revascularization strategy on the clinical status, comorbidities and lesion characteristics in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS). However, the risk and benefit of Culprit Lesion Only (CVO) versus Multi-vessel One-stage Intervention (MVOI) is unclear. We aim to compare the long-term prognosis of NSTE-ACS undergoing CVO and MVOI PCI strategy. Method A total of 4768 consecutive patients with NSTE-ACS who underwent PCI in our hospital in 2013 were enrolled in this study. Patients were divided into CVO group and MVOI group according to whether the culprit vessel was the only target vessel. Prognosis impact on 2-year major adverse cardiovascular and cerebrovascular events (MACCE) is analyzed across 2 groups, including death, cardiac death, myocardial infarction, unplanned revascularization, in-stent thrombosis, stroke and bleeding. Results Compared with CVO group, MVOI patients had generally worse clinical baseline characteristics and angiographic findings, including higher BMI, SYNTAX score, higher proportion of diabetes, hypertension, NSTEMI, tri-vessel disease, total occlusion, etc. Two-year follow-up revealed that MVOI patients have significantly higher rate of unplanned revascularization (10.1% vs. 7.9%, p=0.018), stroke (2.2% vs. 1.3%, p=0.042) and MACCE (14.0% vs. 11.3%, p=0.012). Kaplan-Meier survival analysis yielded similar results. After adjusting for confounding factors by Cox regression analysis, MVOI was shown to be independently associated with higher rate of 2-year in-stent thrombosis (HR = 3.718, 95% CI: 1.125 - 12.293). Two-year Clinical Outcomes CVO (n=3634) MVOI (n=1134) P value All-cause Death 39 (1.1) 13 (1.1) 0.836 Cardiac Death 18 (0.5) 8 (0.7) 0.402 Myocardial Infarction 64 (1.8) 22 (1.9) 0.693 Unplanned Revascularization 287 (7.9) 115 (10.1) 0.018 In-stent Thrombosis 26 (0.7) 12 (1.1) 0.257 Stroke 49 (1.3) 25 (2.2) 0.042 Bleeding 253 (7.0) 67 (5.9) 0.216 MACCE 409 (11.3) 159 (14.0) 0.012 CVO = Culprit Vessel Only; MVOI = Multivessel One-stage Intervention; MACCE = Major Adverse Cardiac and Cerebrovascular Events. Cox Regression Analysis on CVO/MVOI Conclusion In our large cohort of Chinese patients, MVOI strategy for NSTE-ACS patient undergoing PCI was associated with worse 2-year prognosis compared with CVO strategy. MVOI is an independent risk factor for 2-year in-stent thrombosis. Acknowledgement/Funding Ministry of Science and Technology of the People's Republic of China (2016YFC1301301) and National Natural Science Foundation of China (81470486)

The Importance of the Mediastinal Triangle in Traumatic Lesions of the Aorta

Background: Trauma-induced aortic injuries continue to be an important factor in morbimortality in patients with blunt trauma. Objectives: To determine the characteristics of aortic lesions in patients with closed thoracic trauma and associated thoracic injuries. Methods: Multicenter cohort study conducted during the years 1994 to 2014 in the radiology service in the University Hospital Complex of A Coruña. Patients >15 years with closed thoracic trauma were included. Sociodemographic and clinical variables were studied in order to determine the lesion cause, location, and degree. Results: We analyzed 232 patients with a mean age of 46.9 ± 18.7 years, consisting of 81.4% males. The most frequent location was at the level of the isthmus (55.2%). The most frequent causes of injury were traffic accidents followed by falls. Patients with aortic injury had more esophageal, airway, and cardiopericardial lesions. More than 85% of the patients had lung parenchyma and/or chest wall injury, which was more prevalent among those who did not have an aortic lesion. Conclusions: Patients with trauma due to traffic accidents or being run over presented three times more risk of aortic injury than from other causes. Those with an aortic lesion also had a higher frequency of cardiopericardial, airway, and esophageal lesions.

Gender differences in plaque characteristics of nonculprit lesions in patients with coronary artery disease

BackgroundAlthough numerous reports suggest sex-related differences in atherosclerosis, limited data describing gender-associated differences in plaque morphology and composition are currently available. The aim of the present study was to compare coronary nonculprit plaque characteristics in women and men with coronary artery disease (CAD) by optical coherence tomography (OCT).MethodsThis was a retrospective study. A total of 187 nonculprit plaques were identified in 103 patients with CAD who underwent OCT imaging of all 3 coronary arteries. These patients included 77 (74.8%) men and 26 (25.2%) women.ResultsFemale patients were significantly older than males (mean age, 70.8 ± 7.3 vs 60.8 ± 9.8 years; P < 0.001) and less likely to be current smokers (P = 0.007). OCT analysis included the presence of lipid-rich plaque, maximum lipid arc, lipid-core length, lipid index (LI), fibrous cap thickness, and the incidence of thin-cap fibroatheroma (TCFA). Nonculprit plaques in men exhibited greater lipid-core length and LI compared with those of women (9.4 ± 4.5 vs. 7.3 ± 4.3 mm, P = 0.024; 1615.1 ± 893.8 vs. 1237.8 ± 859.8, P = 0.035, respectively). In the univariate linear regression model, sex and current smoker were all associated with a larger LI, whereas only use of statin was independent risk factor for a larger LI in multivariate analysis.ConclusionsCoronary nonculprit plaques in male patients with CAD contain larger lipid cores than those of female patients.

Targeting progression in multiple sclerosis - an update.

In 2018, the distinguishing pathological features of white matter lesions in patients with progressive multiple sclerosis (MS) were refined, and serological and MRI biomarkers of clinical worsening and evolution to progressive MS were identified. We also saw therapeutic advances in progressive MS with the emergence of new neuroprotective strategies and putative markers of neurodegeneration.

Magnetic resonance imaging-guided vacuum-assisted breast biopsy: experience and preliminary results of 205 procedures.

ObjectiveTo demonstrate the frequency of malignancy and histological characteristics of lesions in patients submitted to vacuum-assisted breast biopsy guided by magnetic resonance imaging (MRI).Materials and MethodsThis was a retrospective study of MRI-guided vacuum-assisted breast biopsies performed between April 2008 and December 2016, in which we analyzed clinical and epidemiological data, as well as the BI-RADS classification and histopathological results. We compared nodules and non-nodular enhancements, in terms of their correlation with malignancy, using chi-square test.ResultsAmong 215 cases referred for MRI-guided vacuum-assisted breast biopsy, the procedure was contraindicated in 10 cases (5%) and was technically feasible in the remaining 205 (95%). Non-nodular enhancements were observed in 135 cases (66%), and nodules were observed in 70 (34%), with a mean diameter of 2.2 cm (range, 0.5-9.6 cm) and 0.97 cm (range, 0.5-2.2 cm), respectively. Of the 205 lesions analyzed, 43 (21%) were malignant, 129 (63%) were benign, and 33 (16%) were classified as high-risk lesions. The most common histological findings were invasive ductal carcinoma and, in high-risk cases, lobular neoplasia. There was no significant difference between nodules and non-nodular enhancements in terms of the rate of malignancy (p = 0.725).ConclusionIn our sample, the overall malignancy rate was 21%. However, to improve the assessment of these results, it is necessary to correlate them with the surgical data and with data from the follow-up of benign cases.

Association of Platelet to lymphocyte ratio with non-culprit atherosclerotic plaque vulnerability in patients with acute coronary syndrome: an optical coherence tomography study

BackgroundThe platelet to lymphocyte ratio (PLR), an indirect inflammatory biomarker, has been recently demonstrated to be associated with severity of coronary artery disease. In the present study, we sought to investigate whether PLR is associated with vulnerable plaque characteristics of non-culprit lesions in patients with acute coronary syndrome (ACS).MethodsThe patients in our study were divided into two groups (high PLR group and low PLR group). A total of 119 non-culprit plaques from 71 patients with ACS were assessed by optical coherence tomography (OCT).ResultsThe non-culprit plaques in high PLR group exhibited thinner fibrous cap thickness (FCT) (88.60 ± 44.70 vs. 119.28 ± 50.22 μm, P = 0.001), greater maximum lipid arc (271.73 ± 71.66 vs. 240.60 ± 76.69°, P = 0.027) and increased incidence of thin-cap fibroatheroma (TCFA) (34.0% vs. 15.9%, P = 0.022) compared with those in low PLR group. Meanwhile, PLR was negatively associated with FCT (r = −0.329, P < 0.001). Furthermore, multivariate regression analysis showed that PLR [OR: 1.023 (95% CI: 1.005–1.041), P = 0.012] and LDL-C [OR: 1.892 (95% CI: 1.106–3.239), P = 0.020] were significant predictors of TCFA.ConclusionsHigh level of PLR may be associated with vulnerable plaque features of non-culprit lesions in patients with ACS. PLR, a cheap and easily available index, may surve as a useful inflammatory marker in reflecting plaque vulnerability.

CORONARY ARTERY LESIONS IN PATIENTS OVER 50 YEAR OLD WITH VALVULAR HEART DISEASES INDICATED FOR VALVE SURGERY

Objectives: To investigate the features of coronary artery lesions in patients over 50 with heart valve diseases and to find out the relationship between the levels of coronary artery lesions and heart valve diseases. Results: In patients over 50 year old with heart valve diseases, the rate of significant coronary artery lesions is 55.5%. In which, significant lesions in the group of both mitral and aorta valve diseases is 44.19%, only mitral valve diseases is of 70%, only aortic valve diseases is of 51.85%. There is a relationship between the severity of mitral valve diseases and right coronary artery lesions (OR 3.74: 1.64 to 8.5, p = 0.0017) and circumflex coronary artery lesions (OR 2.59: 1.16 to 5.75, p = 0.0192). The severity of heart valve lesions in significant coronary artery lesions group is higher than insignificant coronary artery lesions group or normal group. Conclusion: Coronary artery lesions is common in patients &gt; 50 years old with heart valve diseases, there is a relationship between the severity of mitral valve diseases and and right coronary artery lesions and circumflex coronary artery lesions. Key words: coronary artery lesions, mitral valvediseases

SPECIFIC CHARACTERISTICS OF BRAIN METASTASIZING IN PATIENTS WITH LUMINAL SUBTYPE OF BREAST CANCER

Background: More than half of female patients with breast cancer are diagnosed with a luminal subtype of the disease; however, specific characteristics of its metastases to the brain have been not well studied, unlike those of HER2 positive and triple negative subtypes. Aim: A comparative analysis of characteristics of metastatic brain lesions in patients with luminal breast cancer. Materials and methods: The time from surgery for breast cancer to the first recurrence and to metastatic brain lesions (assessed by contrast-enhanced MRI imaging) was measured in 41 patients with luminal subtype of breast cancer (median age, 49.5±9.6 years), depending on a diameter of the primary tumor and numbers of involved axillary lymph nodes. Results: The time interval to occurrence of brain metastases in luminal subtype of breast cancer is not associated with the size of the tumor. If≥4 axillary lymph nodes are involved (N2–3), brain metastases are identified much earlier (p<0.05) than in patients with N0–1 (34.5±23.9 months and 62.7±50 months, respectively). Neither the size nor the involvement of axillary lymph nodes has any impact on the rates of metastatic lesion to the brain during the first recurrence. Conclusion: Brain metastases occur at a much shorter time in those patients of luminal subtype of breast cancer who have metastases in≥4 axillary lymph nodes. Brain metastases develop in 50% of patients with the first recurrence of the luminal subtype of breast cancer.

Usefulness of Intravascular Ultrasound for Predicting Risk of Intraprocedural Stent Thrombosis

Intraprocedural stent thrombosis (IPST) is a rare complication of percutaneous coronary intervention that leads to poor outcomes; however, the factors contributing to IPST remain largely unknown. Accordingly, we used intravascular ultrasound (IVUS) to examine the lesion characteristics in patients with IPST. We retrospectively analyzed 1,504 consecutive stent-implanted lesions in 1,324 patients (326 with ST-segment elevation myocardial infarction [STEMI], 403 patients with non-ST-segment elevation acute coronary syndrome [NSTE-ACS], and 595 patients with stable angina). Of these, IPST occurred in 5 patients during percutaneous coronary intervention (0.4% per patient; 3 with STEMI, 2 with NSTE-ACS). The IVUS characteristics of plaques that developed IPST were compared with those of controls without the evidence of IPST (non-IPST; n= 15) who were matched by age, gender, lesion location, and clinical presentation (STEMI, NSTE-ACS, or stable angina). All 5 lesions that led to IPST had ruptured plaques with positive remodeling and attenuation. Plaque rupture was also observed in 40% of the non-IPST group. Multiple plaque ruptures in the culprit lesion were more common in the IPST group (80% vs 7%; p <0.01). The maximum cavity area was larger in the IPST group than in the non-IPST group having plaque rupture (4.6mm(2) [interquartile range, 4.3 to 6.5] vs 2.4mm(2) [1.8 to 2.9]; p <0.01). In conclusion, we found using IVUS that multiple plaque ruptures with larger cavities more often evolved into IPST.

Features of coronary lesions in patients with acute myocardial infarction

Features of coronary lesions in patients with acute myocardial infarction

Clinical and Imaging Analysis of a Cerebellar Watershed Infarction

Objective: To investigate the characteristics of vascular lesions in patients with a cerebellar watershed infarction. Methods: Clinical data from 178 cases of cerebellar infarction were collected with magnetic resonance imaging (MRI) scan results, including diffusion weighted imaging (DWI), a magnetic resonance angiography (MRA), and computed tomography angiography (CTA). The cases were divided into cerebellar watershed and non-watershed infarctions based on lesion location, which was revealed by DWI. Forty-two cases met the criteria for a cerebellar watershed infarction. Based on the MRA/CTA results, the vertebrobasilar artery stenoses were divided into four categories (i.e., intracranial, extracranial, combined, and no detectable stenosis) to compare the vascular lesion characteristics from patients with a cerebellar watershed infarction and patients with a non-watershed infarction. Results: Patients with cerebellar watershed infarcts presented mild symptoms at onset and had a favorable prognosis. However, 90.5% of these patients had a vascular stenosis, which was higher than for patients with a cerebellar non-watershed infarction (74.3%). The four types of vascular lesions, intracranial, extracranial, combined, and no detectable stenosis, were 14.3%, 52.4%, 23.8%, and 9.5% in patients with a cerebellar watershed infarction and 33.8%, 16.2%, 24.3%, and 25.7% in patients with a non-watershed cerebellar infarction, respectively. Conclusion: Although patients with cerebellar watershed infarcts often had comparatively benign clinical manifestations and prognoses, such patients also had a high stenosis prevalence in major blood vessels, especially the extracranial segment in the vertebral artery, which required early intervention and treatment.

Analysis of the characteristics of coronary artery lesions in patients with obstructive sleep apnea-hypopnea syndrome and influencing factors

Objective The current study involved an analysis of the characteristics of coronary artery lesions of patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) and the corresponding influencing factors. Methods One hundred twenty patients were selected by sleep apnea monitoring and coronary angiography. According to the apnea-hypopnea index (AHI), the patients were divided into the following 3 groups: patients with an AHI 15 times/h as the moderate-to-severe OSAHS group (n=63). The clinical and laboratory test data of patients in each group were collected. A single-factor ANOVA and multi-factor logistic regression analysis were performed on the study data to analyze the coronary artery lesions in patients with OSAHS and the corresponding influencing factors. Results (1) With respect to smoking, alcohol consumption, BMI, blood glucose, blood lipids, and blood pressure among the three groups, there were no significant differences between the three groups; however, age did differ among the three groups (P Conclusion The probability of coronary artery lesions increased with OSAHS severity. The main manifestation of the increased possibility was single-vessel coronary artery lesions. In single-vessel disease, the anterior descending branch and the right coronary artery were the most vulnerable, which may be related to the anatomic distribution. Alcohol consumption, age, and AHI are the major risk factors for coronary artery lesions. Alcohol consumption and AHI are major risk factors for single-vessel disease. Age is the main risk factor for multi-vessel disease.

Abstract 17826: Age Difference in Plaque Characteristics of Culprit Lesions in Patients with Acute Coronary Syndrome: an Optical Coherence Tomography Study

Introduction: The relationship between age and culprit plaque characteristics in patients with acute coronary syndrome (ACS) has not been reported. Hypothesis: The characteristics of the culprit plaques differ between younger population and older population with ACS. Methods: We studied 154 patients with ACS who underwent OCT imaging before intervention. The distribution and plaque morphology of the culprit lesion were compared according to the age: Group A (65 years, n=44). Results: There were more smokers in Group A than in Group B and C (58.3% vs. 36.5% vs. 15.9%, p&lt;0.001). Plaque erosion was more frequently observed in the younger age group, whereas plaque rupture was more frequent in the older age group (Figure). The prevalence of calcified nodule was not different among the three groups (Figure). Other features of thin-cap fibroatheroma, thrombus, and macrophage infiltration showed no differences among the three groups. Conclusions: Plaque erosion was the primary cause for ACS in younger patients, whereas plaque rupture was more commonly observed in older patients.

Relationship between cholesterol crystals and culprit lesion characteristics in patients with stable coronary artery disease: an optical coherence tomography study.

Some recent studies have reported the role of cholesterol crystals (ChCs) in plaque rupture in patients with coronary artery disease. We used optical coherence tomography (OCT) to investigate the characteristics of coronary plaques that were associated with derived ChCs. We evaluated 101 subjects with stable coronary artery disease who underwent OCT. We compared the OCT findings of the culprit lesions with ChCs to those without ChCs and investigated the background characteristics. ChCs were observed in culprit lesions of 39 patients. The frequencies of spotty calcification, microchannel structure, and lipid-rich plaque were significantly higher in patients with ChCs than those without ChCs (64.1 vs. 27.4%, p < 0.001; 69.2 vs. 38.7%, p = 0.003; 53.8 vs. 29.0%, p = 0.01, respectively). On the other hand, the frequencies of thrombus, disruption, and thin-cap fibroatheroma did not differ significantly between patients with and without ChCs (15.3 vs. 24.1%, p = 0.3; 33.3 vs. 17.7%, p = 0.07; and 33.3 vs. 24.1 %, p = 0.3, respectively). Among the possible clinical factors, multivariate analysis showed an elevated level of glycated hemoglobin as the sole significant factor associated with ChCs. ChCs are frequently associated with the major findings of vulnerable plaque, and are often seen in poorly controlled diabetic patients. Thus, ChCs might be one of the features of vulnerable plaque.

Intravascular Ultrasound Analysis to Determine the Relationship between High‐Density Lipoprotein Cholesterol and Lesion Characteristics in Patients with Coronary Artery Disease

This study utilized grayscale intravascular ultrasound (IVUS) to explore the relationship between high-density lipoprotein cholesterol (HDL-C) levels and culprit lesion characteristics in patients with coronary artery disease. Low HDL-C is associated with an increased risk of cardiovascular events. Previous IVUS studies have suggested a significant association between lesion characteristics and cardiovascular events. According to HDL-C levels, 120 patients who underwent IVUS for native, de novo coronary lesions before any intervention were divided into a low HDL-C group (<40 mg/dL, n = 60) and a high HDL-C group (≥40 mg/dL, n = 60). Quantitative and qualitative IVUS analyses were performed to compare lesion characteristics. Quantitative IVUS measurements showed no significant differences between the 2 groups. HDL-C level was not significantly correlated with remodeling index (r = 0.03, P = 0.78). However, attenuated plaque was more frequent in the low HDL-C group (48.3% vs. 28.3%, P = 0.02) and a greater percentage of attenuated plaque was found in this group (32.5 ± 21.3% vs. 21.0 ± 11.0%, P = 0.02). Moreover, when categorized into 4 groups according to HDL-C levels, the proportion of attenuated plaque (64.7% in group with <30 mg/dL, 41.9% in group with 30-39 mg/dL, 36.4% in group with 40-59 mg/dL, and 6.3% in group with ≥60 mg/dL; P = 0.001 for trend) was significantly different among groups. On multivariate analysis, only HDL-C and male gender were independently associated with the presence of attenuated plaque at the culprit lesions. Patients with low levels of HDL-C may be at increased risk of having a higher incidence of attenuated plaques.

Correlation analysis between depressive manifestations and morphological lesion characteristics in patients with stroke

Introduction: Knowledge of etiopathogenesis of post-stroke depressive phenomena contributes to early diagnostics which shortens recovery to a great extent and suits the social and professional rehabilitation of patients, if followed by proper psycho/pharmacotherapy. The aim of this work is to research dependence of depressive manifestations considering the size and anatomical localization of lesion. Subjects and Methods: The research included 118 patients with stroke. Lesion localization was defined on computerized axial tomography records, whereas the area and perimeter of lesion were measured by AutoCAD 2004 software. Examinations by means of Hamilton Rating Scale for Depression were carried out by the method of random selection 11-40 days after stroke. Correlation analysis was made by simple linear/non-linear regression and Cox's hazard regression model. Results: Negative correlation was observed between the intensity of depressive manifestations and the size of cerebrovascular lesion (Spearman's r = - 0.263, P = 0.004). By means of Cox's regression model we determined 4.389 times higher risk for depression occurrence in female patients (P < 0.001), as well as higher risk due to lobus limbicus structure damages (hazard ratio eb (HR) = 2.661, P = 0.019). Conclusion: Lower intensity of depressive manifestations with larger cerebrovascular lesions, we have explained by activation of reparation mechanisms with energy savings and decrease (due to neurological deficits) of afferent peripheral sensations which antecedent the occurrence of emotions (James-Lange peripheral theory of emotions).

The effect of glycaemic control on the quantitative characteristics of retinopathy lesions in patients with type 2 diabetes mellitus: 10-year follow-up study

Diabetic retinopathy (DR) represents a common complication of type 2 diabetes mellitus. Appearance of DR lesions such as microaneurysms, haemorrhages, hard and soft exudates, IRMA and neovascularisation reflect the severity of DR. The aim of our study was to investigate the association of selected glycaemic parameters with particular DR abnormalities and their characteristics in patients with type 2 diabetes. Eighty-three middle-aged patients with newly diagnosed type 2 diabetes mellitus participated in this 10-year prospective study. The glycaemic parameters such as glycated haemoglobin A1c (HbA1c), fasting blood/plasma glucose as well as 1- and 2-hour post-load glucose values were recorded at baseline, 5-year and 10-year follow-up. The fundus photographs were taken at baseline and then at 5-year and 10-year follow-ups and used for quantitative evaluation. Statistically significant positive correlations were found between all investigated 5-year glucose values and the extent of DR lesions at 10-year follow-up (p < 0.003). The 1- and 2-hour post-load glucose values correlated with the DR lesions with the highest significance (p <or= 0.001). There were also associations between glycaemia and DR lesions investigated in a cross-sectional manner at 10-year follow-up. Binary logistic regression revealed that all glycaemic parameters at 5-year examination predicted the development of DR at 10-year follow-up (p <or= 0.001). The most powerful predictor of DR was the 2-hour post-load glucose value, since it explained almost 50% of DR cases. Five-year blood glucose values predict the amount of DR lesions at 10-year follow-up in patients with recently diagnosed type 2 diabetes. The 2-hour post-load glucose at 5-year measurement appears to be the most reliable parameter predicting 10-year DR lesions.

Radiological features of breast benign lesions in patients with hyperprolactinemia

Background: The study was conducted to determine whether prolactin (PRL) influences radiological features of benign breast lesions. Methods: During the 4-year period, we observed 50 patients with nipple discharge: 23 with normal serum prolactin levels (group 1) and 27 with hyperprolactinemia (group 2a before hyperprolactinemia treatment and group 2b after hyperprolactinemia treatment). Patients observed during this study underwent breast ultrasonography (US) and mammography. Radiological findings in group 1, group 2a and group 2b were compared. Results: The most frequent radiological findings in group 2a were dilated lactiferous ducts and cystic lesions with statistical significances p&lt;0.001 and p&lt;0.01 in comparison to other radiological findings. In group 1 significantly less presence of dilated lactiferous ducts was observed (p&lt;0.05) and proportional lower frequency of solid lumps compared to group 2a. Our results showed significantly lower incidence (p&lt;0.001) of dilated lactiferous ducts, after hyperprolactinemia treatment (group 2b). In group 2b less presence of solid lumps and enlarged axillary lymph nodes is also observed in comparison to group 2a. Frequency of cystic lesions significantly decreased (p&lt;0.05) and pseudocysts completely withdrew in patients with normalized serum prolactin levels. Conclusion: Prolactin significantly influences radiological presentation of benign breast diseases. Treatment of hyperprolactinemia results in withdrawal of mammary duct ectasia, pseudocystic formations, cystic lesions and solid lumps. Breast ultra-sonography and mammography should be considered as routine diagnostic procedures in patients with hyperprolactinemia.

Predicting No-reflow Based on Angiographic Features of Lesions in Patients with Acute Myocardial Infarction

We tried to elucidate angiographical predictors of no-reflow and to determine a preferable recanalization therapy based on the morphology of lesions. Seventy-six patients were randomly assigned into groups to receive primary angioplasty (n = 41) or intracoronary thrombolysis (n = 35). Based on angiography, occlusive infarct-related lesions were divided into thrombus-rich and hard plaque lesions. The outcome of the two therapies used for each lesion was compared. The incidence of no-reflow was higher in the thrombus-rich than hard plaque lesions (38 percent vs. 0 percent, p = 0.006); the left ventricular ejection fraction in the chronic phase was lower (46 +/- 6 percent vs. 55 +/- 5 percent, p < 0.001) for primary angioplasty than thrombolysis. No-reflow was not observed in the hard plaque lesions. However, the incidence of additional reperfusion therapy (88 percent vs. 8 percent, p < 0.001) was higher in the patients who underwent thrombolysis rather than primary angioplasty. We suggest that thrombus-rich lesions in primary angioplasty may predict no-reflow in acute myocardial infarction, and thrombolysis prior to angioplasty may be preferable for these lesions. We also suggest that primary angioplasty may be more effective than thrombolysis for hard plaque lesions.

Lesion Characteristics in Patients with Acute Coronary Syndrome: A Comparison with Lesion in Patients with Stable Angina by Intravascular Ultrasound

Background and Objectives：The pathophysiology of acute coronary syndrome (ACS) is plaque rupture with thrombus formation, which is different from that of stable angina pectoris (SA). Intravascular ultrasound (IVUS) prior to percutaneous coronary intervention provides information on the plaques and vessel wall itself. The purpose of this study was to evaluate the lesion characteristics of ACS prior to coronary intervention compared to those of SA lesions by IVUS. Subjects and Methods：Pre-interventional IVUS was performed on 68 culprit lesions in 41 ACS and 25 SA patients. The plaque morphology, lumen and vessel sizes, and arterial remodeling pattern at the lesion segment were analyzed in both groups. A plaque rupture was defined as a plaque containing a cavity that communicated with the lumen, which was covered with a fibrous cap. Results：Positive remodeling was more frequent in patients with ACS than those with SA (42 vs. 11%), whereas negative remodeling was more frequent in patients with SA (22 vs. 41%) (p=0.023). Plaque rupture/dissection and thrombus was more frequent (51 vs. 19%, p=0.006 and 39 vs. 4%, p=0.001) in patients with ACS. Lesions with ACS had significantly larger EEM CSA, plaque CSA and plaque burden (p<0.05). There were no significant differences in the clinical parameters, angiographic parameters and plaque morphologies. Conclusion：Positive remodeling, plaque rupture/dissection and thrombus were more frequently observed in patients with ACS. In addition, lesions with ACS had a larger vessel size and a higher plaque burden. The type of remodeling, plaque rupture or dissection, thrombus and amount of plaques might have an impact on the clinical presentation. (Korean Circulation J 2004;34(6):548-557)