Evidence of Cholesterol Crystals in Atherosclerotic Plaque by Optical Coherence Tomographic (OCT) Imaging
G.J. Tearney, I.K. Jang, B.E. Bouma
Massachusetts General Hospital, Boston, USA.
Research investigating the biomechanical properties of atherosclerotic plaques has shown that the presence of cholesterol crystals increases the stiffness of lipid pools,and as a result, may decrease the likelihood of plaque rupture [Loree HM et al. Arteriosclerosis and Thrombosis 1994;14:230-4]. Optical coherence tomography (OCT) is an optical analog of IVUS with high resolution (10 [micro]m vs.100 [micro]m of IVUS) that has been developed in our laboratory for clinical investigation. In an aortic plaque obtained postmortem from a 74-year-old male with a history of myocardial infarction, correlation between OCT imaging (A) and histology (B, Masson's trichrome; original magnification 40[times]) demonstrated the presence of cholesterol crystals (arrows in A, B) which appeared as oriented, linear, highly reflecting structures near the fibrous cap-lipid pool junction. A 40-year-old male with myocardial infarction 1 week prior to intervention underwent cardiac catheterization. The coronary angiogram (C) revealed 80% stenosis of the right coronary artery. Pre-intervention intracoronary OCT imaging was performed at a location distal to the culprit lesion (arrow in C) using a 3.0 F OCT catheter, showing a lipid-rich plaque (LP) with a thick fibrous cap (FC). In this coronary plaque, oriented linear structures consistent with cholesterol crystals,were also observed by OCT (arrows in D). This image represents the first visualization of cholesterol crystals in a living patient.
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