| 최윤하, 홍영준¹ , 김상욱² , 정명호¹ , 이왕수² , 이광재² , 김태호² , 박근호¹ , 심두선¹ , 김주한¹ , 안영근¹ , 조정관¹ , 박종춘¹ , 김치정² , 류왕성² , 강정채¹ |
BACKGROUND: The virtual histology-intravascular ultrasound (VH-IVUS) findings which are associated with plaque prolapse (PP) after stent implantation are not well known.
OBJECTIVES: We evaluated the relationship between pre-stenting plaque components assessed by VH-IVUS and post-stenting PP.
METHODS: This study group comprised 66 patients (76 PP lesions) who underwent pre-stenting VH-IVUS and stent implantation. Of these patients, 34 patients had 38 PP lesions and 32 patients had 38 non-PP lesions. VH-IVUS classified the color-coded tissue into four major components: fibrotic (FT); fibro-fatty (FF); dense calcium (DC); and necrotic core (NC). Thin-cap fibroatheroma (TCFA) was defined as a NC≥10% of plaque area in ≥3 consecutive frames without evident overlying fibrous tissue in the presence of ≥40% plaque burden.
RESULTS: External elastic membrane area (17.3±5.7 mm2 vs. 13.1±4.7 mm2, p=0.001), plaque area (13.1±4.7 mm2 vs. 8.9±4.1 mm2, p<0.001), and plaque burden (73±13% vs. 66±9%, p=0.006) at the minimum lumen sites were significantly greater in PP lesions. Absolute FT, FF, and NC plaque area components were greater at the minimum lumen sites in PP lesions compared with non-PP lesions (FT: 5.66±3.63 mm2 vs. 3.31±2.59 mm2, p=0.002, FF: 1.04±1.17 mm2 vs. 0.52±0.67 mm2, p=0.021, DC: 0.82±0.73 mm2 vs. 0.66±0.58 mm2, p=0.3, NC: 2.01±1.25 mm2 vs. 1.36±1.04 mm2, p=0.015). Plaque volume was greater in PP lesions compared with non-PP lesions (235±123 mm3 vs. 185±93 mm3, p=0.050). Absolute FT and NC plaque volumes were greater in PP lesions compared with non-PP lesions (FT: 87±56 mm3 vs. 57±41 mm3, p=0.010, FF: 17±15 mm3 vs. 13±18 mm3, p=0.3, DC: 16±15 mm3 vs. 11±8 mm3, p=0.093, NC: 32±24 mm3 vs. 19±13 mm3, p=0.004). TCFA was observed more frequently in PP lesions compared with non-PP lesions (63% vs. 34%, p=0.012). By multivariate analysis, absolute NC volume (OR 1.138, 95% CI 1.064-1.216, p<0.001) and absolute FT volume (OR 1.093, 95% CI 1.041-1.148, p<0.001) were the independent predictors of PP.
CONCLUSIONS: PP lesions have larger vessel with larger plaque, and absolute NC and FT plaque components were associated with development of PP after stent implantation.
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