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Layered plaque and plaque volume in patients with acute coronary syndromes.

Authors :: Yuki H
Kinoshita D
Suzuki K
Niida T
Nakajima A
Seegers LM
Vergallo R
Fracassi F
Russo M
Di Vito L
Bryniarski K
McNulty I
Lee H
Kakuta T
Nakamura S
Jang IK
Source :: Journal of thrombosis and thrombolysis [J Thromb Thrombolysis] 2023 Apr; Vol. 55 (3), pp. 432-438. Date of Electronic Publication: 2023 Mar 04.
Publication Year :: 2023
Abstract: Background: Layered plaque is a signature of previous subclinical plaque destabilization and healing. Following plaque disruption, thrombus becomes organized, resulting in creation of a new layer, which might contribute to rapid step-wise progression of the plaque. However, the relationship between layered plaque and plaque volume has not been fully elucidated. Methods: Patients who presented with acute coronary syndromes (ACS) and underwent pre-intervention optical coherence tomography (OCT) and intravascular ultrasound (IVUS) imaging of the culprit lesion were included. Layered plaque was identified by OCT, and plaque volume around the culprit lesion was measured by IVUS. Results: Among 150 patients (52 with layered plaque; 98 non-layered plaque), total atheroma volume (183.3 mm <superscript>3</superscript> [114.2 mm <superscript>3</superscript> to 275.0 mm <superscript>3</superscript> ] vs. 119.3 mm <superscript>3</superscript> [68.9 mm <superscript>3</superscript> to 185.5 mm <superscript>3</superscript> ], p = 0.004), percent atheroma volume (PAV) (60.1%[54.7-60.1%] vs. 53.7%[46.8-60.6%], p = 0.001), and plaque burden (86.5%[81.7-85.7%] vs. 82.6%[77.9-85.4%], p = 0.001) were significantly greater in patients with layered plaques than in those with non-layered plaques. When layered plaques were divided into multi-layered or single-layered plaques, PAV was significantly greater in patients with multi-layered plaques than in those with single-layered plaques (62.1%[56.8-67.8%] vs. 57.5%[48.9-60.1%], p = 0.017). Layered plaques, compared to those with non-layered pattern, had larger lipid index (1958.0[420.9 to 2502.9] vs. 597.2[169.1 to 1624.7], p = 0.014). Conclusion: Layered plaques, compared to non-layered plaques, had significantly greater plaque volume and lipid index. These results indicate that plaque disruption and the subsequent healing process significantly contribute to plaque progression at the culprit lesion in patients with ACS. Clinical Trial Registration: http://www. Clinicaltrials: gov , NCT01110538, NCT03479723, UMIN000041692. (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)