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Relationship Among Transducer Frequency and Virtual Histology and Grayscale IVUS Detection of Attenuated Plaques |
인제대학교 일산백병원¹ , Cardiovascular Research Foundation² , 중앙대학교병원 ³ , 전남대학교병원⁴ |
이성윤¹, Gary S. Mintz² ,김상욱³ ,홍영준⁴,도준형¹, 권성욱¹ ,최현민¹ ,남궁준¹ ,이원로¹ |
Background: Attenuated plaque on grayscale intravascular ultrasound (IVUS) is associated with acute coronary syndromes (ACS) and a high risk of no-reflow or CK-MB elevation post-percutaneous coronary intervention.
Methods: Pre-PCI using 40MHz, rotation-transducer IVUS catheters, we detected 36 attenuated plaques (hypoechoic plaque with deep ultrasound attenuation) in 32 ACS pts including 11 ST-elevation myocardial infarction pts. We then systematically repeated IVUS using 20MHz, electronic-array IVUS catheters that also permitted virtual histology (VH)-IVUS analysis.
Results: Among 36 attenuated plaques detected by 40MHz mechanical IVUS imaging, only 6 were also detected by 20MHz electronic-array IVUS; and the angle (80.4±11.2 vs 116.6±19.3, p=0.003) and length (2.7±1.3mm vs 3.8±1.8mm, p=0.019) were smaller. On VH-IVUS analysis all 36 attenuated plaques were the result of a significant necrotic core (NC) and adjacent fibrofatty plaque. Overall, NC volume measured 18.4±11.1%,dense calcium volume measured 3.9±5.4%, fibro-fatty volume measured 15.2±10.9%, and fibroic tissue volume measured 62.5±9.9%.
Conclusions: Detection of attenuated plaque depends on transducer frequency and, perhaps, other differences between mechanical and electronic-array systems. In VH-IVUS analysis showed that attenuated plaques were comprised of large volumes of necrotic core and fibrous fatty plaque.
IVUS findings with mechanical catheter (A), electronic-array catheter (B) and VH-IVUS (C) of attenuated plaque at mid RCA.
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