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European Heart Journal Advance Access published online on April 7, 2008
European Heart Journal, 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
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that the original authorship is properly and fully attributed; the Journal, Learned Society and Oxford University Press are attributed as the original place of publication with correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org.

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.

* 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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