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European Heart Journal Advance Access originally published online on April 7, 2008
European Heart Journal 2008 29(9):1136-1146; doi:10.1093/eurheartj/ehn132
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org
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Feasibility of combined use of intravascular ultrasound radiofrequency data analysis and optical coherence tomography for detecting thin-cap fibroatheroma

Takahiro Sawada1, Junya Shite1,*, Hector M. Garcia-Garcia2, Toshiro Shinke1, Satoshi Watanabe1, Hiromasa Otake1, Daisuke Matsumoto1, Yusuke Tanino1, Daisuke Ogasawara1, Hiroyuki Kawamori1, Hiroki Kato1, Naoki Miyoshi1, Mitsuhiro Yokoyama1, Patrick W. Serruys2 and Ken-ichi Hirata1

1 Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
2 Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands

Received 5 October 2007; revised 25 February 2008; accepted 6 March 2008; online publish-ahead-of-print 7 April 2008.

* Corresponding author. Tel: +81 78 382 5846, Fax: +81 78 382 5859, Email: shite{at}med.kobe-u.ac.jp

Aims: To evaluate the feasibility of the combined use of virtual histology (VH)-intravascular ultrasound (IVUS) and optical coherence tomography (OCT) for detecting in vivo thin-cap fibroatheroma (TCFA).

Methods and results: In 56 patients with angina, 126 plaques identified by IVUS findings were analysed using both VH-IVUS and OCT. IVUS-derived TCFA was defined as an abundant necrotic core (>10% of the cross-sectional area) in contact with the lumen (NCCL) and %plaque-volume >40%. OCT-derived TCFA was defined as a fibrous cap thickness of <65 µm overlying a low-intensity area with an unclear border. Plaque meeting both TCFA criteria was defined as definite-TCFA. Sixty-one plaques were diagnosed as IVUS-derived TCFA and 36 plaques as OCT-derived TCFA. Twenty-eight plaques were diagnosed as definite-TCFA; the remaining 33 IVUS-derived TCFA had a non-thin-cap and eight OCT-derived TCFA had a non-NCCL (in discord with NCCL visualized by VH-IVUS, mainly due to misreading caused by dense calcium). Based on IVUS findings, definite-TCFA showed a larger plaque and vessel volume, %plaque-volume, higher vessel remodelling index, and greater angle occupied by the NCCL in the lumen circumference than non-thin-cap IVUS-derived TCFA.

Conclusion: Neither modality alone is sufficient for detecting TCFA. The combined use of OCT and VH-IVUS might be a feasible approach for evaluating TCFA.

Key Words: Thin-cap fibroatheroma • VH-IVUS • OCT • Necrotic core • Vessel positive remodelling


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