Abstract
Recently it has been reported that the lipid core area and the fibrous cap thickness cannot be deduced from the stenotic ratio. However, there is no comparative study between yellow and white plaques. This study assessed the precise characterization of yellow and white plaques using angioscopy. We observed 198 segments of coronary from autopsy artery using angioscopy, then 46 yellow plaque lesions and 61 white plaque lesions of atheroma were excised and prepared for pathological examination. The stenotic ratio, the plaque area (PA), the lipid core size as a percentage of total vessel area (%C), and the minimum fibrous cap thickness (FCt) were measured and compared between yellow and white plaque groups. In this study, the stenotic ratio and the PA were significantly larger in the white plaque group (p<.001). The FCt was significantly thinner in the yellow plaque group (58±18 µm vs. 648±356 µm p<.0001). There was no correlation between the stenotic ratio and the %C in the whole cases (r=.22). Although it was the same in the white plaque group (r=.13), significant correlation between them was shown in the yellow plaque group (r=.64). No significant correlation was observed between the stenotic ratio and the FCt in each plaque group. We concluded that a yellow plaque with moderate stenosis could be diagnosed as a vulnerable plaque by the combination of coronary angiography and angioscopy.
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Aikawa M, Rabkin E, Okada Y, Voglic SJ, Clinto SK, Brinckerhoff CE, Sukhova GK, Libby P (1998) Lipid lowering by diet reduces matrix metalloproteinase activity and increases collagen content of rabbit atheroma: a potential mechanism of lesion stabilization. Circulation 97:2433–2444.
Cliff WJ, Heathcote CR, Moss NS, Reichenbach DD (1988) The coronary arteries in cases of cardiac and noncardiac sudden death. Am J Pathol 132:319–329.
Davies MJ, Thomas AC (1985) Plaque fissuring: the cause of acute myocardial infarction, sudden ischaemic death and crescendo angina. Br Heart J 53:363–373.
Davies MJ, Richardson PD, Woolf N, Katz DR, Mann J (1993) Risk of thrombosis in human atherosclerotic plaques: role of extracellular lipid, macrophage and smooth muscle cell content. Br Heart J 69:377–381.
de Feyter PJ, Ozaki Y, Baptista J, Escaned J, Di Mario C, de Jaegere PP, Serruys PW, Roelandt JR (1995) Ischemia-related lesion characteristics in patients with stable or unstable angina. A study with intracoronary angioscopy and ultrasound. Circulation 92:1408–1413.
Falk E (1989) Morphologic features of unstable atherothrombotic plaques underlying acute coronary syndromes. Am J Cardiol 63:114E-120E.
Fleming RM, Gibbs HR, Swafford J (1992) Using quantitative coronary arteriography to redefine SPECT sensitivity and specificity. Am J Physiol Imaging 7:59–65.
Fleming RM, Boyd L, Foster M (2000) Angina is caused by regional blood flow differences. ACC-ESC Conference, 12 March 2000 Anaheim, CA.
Fleming RM, Boyd L (2000) Regional blood flow differences induced by high dose dipyridamole explain etiology of angina. Third International Congress on Coronary Artery Disease, 4 October 2000 Lyon, France.
Fuster V, Badimon L, Badimon JJ, Chesebro JH (1992) The pathogenesis of coronary artery disease and the acute coronary syndromes. N Engl J Med 326:242–250.
Hackett D, Davies G, Maseri A (1988) Pre-existing coronary stenoses in patients with first myocardial infarction are not necessarily severe. Eur Heart J 9:1317–1323.
Haft JJ, Haik BJ, Goldstein JE, Brodyn NE (1988) Development of significant coronary artery lesions in areas of minimal disease: a common mechanism for coronary disease progression. Chest 94:731–736.
Hangartner JR, Charleston AJ, Davies MJ, Thomas AC (1986) Morphological characteristics of clinically significant coronary artery stenosis in stable angina. Br Heart J 56:501–508.
Kitamura K, Mizuno K, Miyamoto A, Nakamura H (1997) Serum lipid profiles and the presence of yellow plaque in coronary lesions in vivo. Am J Cardiol 79:676–679.
Kragel AH, Reddy SG, Wittes JT, Roberts WC (1989) Morphometric analysis of the composition of atherosclerotic plaques in the four major epicardial coronary arteries in acute myocardial infarction and in sudden coronary death. Circulation 80:1747–1756.
Kragel AH, Reddy SG, Wittes JT, Roberts WC (1990) Morphometric analysis of the composition of coronary arterial plaques in isolated unstable angina pectoris with pain at rest. Am J Cardiol 66:562–567.
Kragel AH, Gertz SD, Roberts WC (1991) Morphologic comparison of frequency and types of acute lesions in the major epicardial coronary arteries in unstable angina pectoris, sudden coronary death and acute myocardial infarction. J Am Coll Cardiol 18:801–808.
Mann JM, Davies MJ (1996) Vulnerable plaque: relation of characteristics to degree of stenosis in human coronary arteries. Circulation 94:928–931.
Miyamoto A, Friedl SE, Lin FC, Nesto RW, Abela GS (1995) Plaque cap thickness can be detected by quantitative color analysis of angioscopic images in a plaque model. In: Lasers in Surgery: Advanced Characterization, Therapeutics, and Systems V, Anderson R (ed). WA; Bellingham, Proc/SPIE-The International Society for Optical Engineering; neering; May, 2395:429.
Mizuno K, Arai T, Satomura K, Shibuya T, Arakawa K, Okamoto Y, Miyamoto A, Kurita A, Kikuchi M, Nakamura H, Utsumi A, Takeuchi K (1989) New percutaneous transluminal coronary angioscope. J Am Coll Cardiol 13:363–368.
Mizuno K, Miyamoto A, Satomura K, Kurita A, Arai T, Sakurada M, Yanagida S, Nakamura H (1991) Angioscopic coronary macromorphology in patients with acute coronary disorders. Lancet 337:809–812.
Mizuno K, Satomura K, Miyamoto A, Arakawa K, Shibuya T, Arai T, Kurita A, Nakamura H, Ambrose JA (1992) Angioscopic evaluation of coronary artery thrombi in acute coronary syndromes. N Engl J Med 326:287–291.
Pitt B, Mancini GB, Ellis SG, Rosman HS, Park JS, McGovern ME (1995) Pravastatin limitation of atherosclerosis in the coronary arteries (PLAC I): reduction in atherosclerosis progression and clinical events. PLAC I investigation. J Am Coll Cardiol 26:1133–1139.
Ramee SR, White CJ, Collins TJ, Mesa JE, Murgo JP (1991) Percutaneous angioscopy during coronary angioplasty using a steerable microangioscope. J Am Coll Cardiol 17:100–105.
Richardson PD, Davies MJ, Born GD (1989) Influence of plaque configuration and stress distribution on fissuring of coronary atherosclerotic plaques. Lancet 2:941–944.
Roelandt JRC, di Mario C, Pandian NG, Wenguang L, Keane D, Slager CJ, de Feyter PJ, Serruys PW (1994) Three-dimensional reconstruction of intracoronary ultrasound images: rationale, approaches, problems, and directions. Circulation 90:1044–1055.
Topol EJ, Nissen SE (1995) Our preoccupation with coronary luminology—the dissociation between clinical and angiographic finding in ischemic heart disease. Circulation 92:2333–2342.
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Isoda, K., Satomura, K. & Ohsuzu, F. Pathological characterization of yellow and white plaques under angioscopy. International Journal of Angiology 10, 183–187 (2001). https://doi.org/10.1007/BF01616981
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DOI: https://doi.org/10.1007/BF01616981