Characteristics of Coronary Artery Vulnerable Plaque on Coronary Computed Tomography Angiography (CCTA) and Optical Coherence Tomography (OCT) - A Review Article
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Abstract
Abstract
Background: The most common cause of sudden coronary deaths is atherosclerotic plaque rupture and subsequent coronary artery thrombosis. Plaques that have high risk features are called vulnerable plaques, and are the precursor of acute coronary events and are characterized by a large necrotic core and a thin fibrotic cap in histopathology. Coronary Computed Tomography Angiography (CCTA) is a clinically established tool for the diagnosis of coronary artery disease, evaluation of coronary artery stenosis and characterization of the plaque. OCT has emerged as the most accurate imaging modality for the evaluation of intracoronary Thin Cap Fibroatheroma (TCFA).
Methods: We performed a thorough online search of full text articles on characteristics of vulnerable plaque on CCTA and OCT in English literature. After doing a critical appraisal a comprehensive review has been described.
Conclusion: In this review we have described the features of vulnerable plaque like napkin ring sign, low attenuation index and positive remodeling index on CCTA with simultaneous evaluation of thin cap fibroatheroma on OCT.
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Dr. Kishan Singh Rawat, Department of Radiology, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi-110060, India
MD,Senior Consultant,Department of CT and MRI
Dr. Tarvinder Bir Singh Buxi, Department of Radiology, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi-110060, India
MD, Advisor, Department of CT and MRI
Dr. Anurag Yadav, Department of Radiology, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi-110060, India
DNB, Senior Consultant, Department of CT and MRI.
Dr. Samarjit Singh Ghuman, Department of Radiology, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi-110060, India
MD, Senior Consultant, Department of CT and MRI
Dr Arun Mohanty, Department of Radiology, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi-110060, India
MD,Consultant,Department Of Cardiology
Dr. Varun Holla, Department of Radiology, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi-110060, India
DNB resident
Hay SI, Abajobir AA, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, et al. Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390:1260-344. Available from: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32130-X/fulltext
Gagan D, Flora M, Nayak MK. A Brief Review of Cardiovascular Diseases, Associated Risk Factors and Current Treatment Regimes. Curr Pharm Des. 2019;25:4063-84. Available from: https://doi.org/10.2174/1381612825666190925163827
Hamon M, Morello R, Riddell JW, Hamon M. Coronary arteries: diagnostic performance of 16- versus 64-section spiral CT compared with invasive coronary angiography—meta-analysis. Radiology. 2007;245:720-31. Available from: https://doi.org/10.1148/radiol.2453061899
Motoyama S, Kondo T, Anno H, Sugiura A, Ito Y, Mori K, et al. Atherosclerotic plaque characterization by 0.5-mm-slice multislice computed tomographic imaging. Circ J. 2007;71:363-6. Available from: https://doi.org/10.1253/circj.71.363
Motoyama S, Kondo T, Sarai M, Sugiura A, Harigaya H, Sato T, et al. Multislice computed tomographic characteristics of coronary lesions in acute coronary syndromes. J Am Coll Cardiol. 2007;50:319-26. Available from: https://doi.org/10.1016/j.jacc.2007.03.044
Uemura S, Ishigami K, Soeda T, Okayama S, Sung JH, Nakagawa H, et al. Thin-cap fibroatheroma and microchannel findings in optical coherence tomography correlate with subsequent progression of coronary atheromatous plaques. Eur Heart J. 2012;33:78-85. Available from: https://doi.org/10.1093/eurheartj/ehr284
Stone GW, Maehara A, Lansky AJ, de Bruyne B, Cristea E, Mintz GS, et al. PROSPECT Investigators. A prospective natural-history study of coronary atherosclerosis. N Engl J Med. 2011;364(3):226-35. Available from: https://doi.org/10.1056/nejmoa1002358
Wang JC, Normand SL, Mauri L, Kuntz RE. Coronary artery spatial distribution of acute myocardial infarction occlusions. Circulation. 2004;110:278-84. Available from: https://doi.org/10.1161/01.cir.0000135468.67850.f4
Andreini D, Pontone G, Mushtaq S, Bartorelli AL, Bertella E, Antonioli L, et al. A long-term prognostic value of coronary CT angiography in suspected coronary artery disease. JACC Cardiovasc Imaging. 2012;5:690-701. Available from: https://doi.org/10.1016/j.jcmg.2012.03.009
Motoyama S, Ito H, Sarai M, Kondo T, Kawai H, Nagahara Y, et al. Plaque characterization by coronary computed tomography angiography and the likelihood of acute coronary events in mid-term follow-up. J Am Coll Cardiol. 2015;66:337-46. Available from: https://doi.org/10.1016/j.jacc.2015.05.069
Voros S, Rinehart S, Qian Z, Joshi P, Vazquez G, Fischer C, et al. Coronary atherosclerosis imaging by coronary CT angiography: current status, correlation with intravascular interrogation and meta-analysis. JACC Cardiovasc Imaging. 2011;4:537-48. Available from: https://doi.org/10.1016/j.jcmg.2011.03.006
Bom MJ, van der Heijden DJ, Kedhi E, van der Heyden J, Meuwissen M, Knaapen P, et al. Early Detection and Treatment of the Vulnerable Coronary Plaque: Can We Prevent Acute Coronary Syndromes? Circ Cardiovasc Imaging. 2017;10(5):e005973. Available from: https://doi.org/10.1161/circimaging.116.005973
Tearney GJ, Regar E, Akasaka T, Adriaenssens T, Barlis P, Bezerra HG, et al. Consensus standards for acquisition, measurement, and reporting of intravascular optical coherence tomography studies: A report from the international working Group for Intravascular Optical Coherence Tomography Standardization and Validation. J Am Coll Cardiol. 2012;59(12):1058-1072. Available from: https://doi.org/10.1016/j.jacc.2011.09.079
Glagov S, Weisenberg E, Zarins CK, Stankunavicius R, Kolettis GJ. Compensatory enlargement of human atherosclerotic coronary arteries. N Engl J Med. 1987;316:1371-1375. Available from: https://doi.org/10.1056/nejm198705283162204
Maurovich-Horvat P, Schlett CL, Alkadhi H, Nakano M, Otsuka F, Stolzmann P, et al. The napkin-ring sign indicates advanced atherosclerotic lesions in coronary CT angiography. JACC Cardiovasc Imaging. 2012;5(12):1243-52. Available from: https://doi.org/10.1016/j.jcmg.2012.03.019
Shmilovich H, Cheng VY, Tamarappoo BK, Dey D, Nakazato R, Gransar H, et al. Vulnerable plaque features on coronary CT angiography as markers of inducible regional myocardial hypoperfusion from severe coronary artery stenoses. Atherosclerosis. 2011;219:588-95. Available from: https://doi.org/10.1016/j.atherosclerosis.2011.07.128
Yabushita H, Bouma BE, Houser SL, Aretz HT, Jang IK, Schlendorf KH, et al. Characterization of human atherosclerosis by optical coherence tomography. Circulation. 2002;106(13):1640-5. Available from: https://doi.org/10.1161/01.cir.0000029927.92825.f6
Yang DH, Kang SJ, Koo HJ, Chang M, Kang JW, Lim TH, et al. Coronary CT angiography characteristics of OCT-defined thin-cap fibroatheroma: a section-to-section comparison study. Eur Radiol. 2018;28:833-43. Available from: https://doi.org/10.1007/s00330-017-4992-8
Tomizawa N, Yamamoto K, Inoh S, Nojo T, Nakamura S. Accuracy of computed tomography angiography to identify thin-cap fibroatheroma detected by optical coherence tomography. J Cardiovasc Comput Tomogr. 2017;11(2):129-134. Available from: https://doi.org/10.1016/j.jcct.2017.01.010
Nakazato R, Otake H, Konishi A, Iwasaki M, Koo BK, Fukuya H, et al. Atherosclerotic plaque characterization by CT angiography for identification of high-risk coronary artery lesions: A comparison to optical coherence tomography. Eur Heart J Cardiovasc Imaging. 2015;16:373-9. Available from: https://doi.org/10.1093/ehjci/jeu188
Kashiwagi M, Tanaka A, Kitabata H, Tsujioka H, Kataiwa H, Komukai K, et al. Feasibility of noninvasive assessment of thin-cap fibroatheroma by multidetector computed tomography. JACC Cardiovasc Imaging. 2009;2:1412-1419. Available from: https://doi.org/10.1016/j.jcmg.2009.09.012
Ozaki Y, Okumura M, Ismail TF, Motoyama S, Naruse H, Hattori K, et al. Coronary CT angiographic characteristics of culprit lesions in acute coronary syndromes not related to plaque rupture as defined by optical coherence tomography and angioscopy. Eur Heart J. 2011;32:2814-2823. Available from: https://doi.org/10.1093/eurheartj/ehr189
Maurovich-Horvat P, Hoffmann U, Vorpahl M, Nakano M, Virmani R, Alkadhi H. The napkin-ring sign: CT signature of high risk coronary plaques? JACC Cardiovasc Imaging. 2010;3:440-444. Available from: https://doi.org/10.1016/j.jcmg.2010.02.003
Pflederer T, Marwan M, Schepis T, Ropers D, Seltmann M, Muschiol G, et al. Characterization of culprit lesions in acute coronary syndromes using coronary dual-source CT angiography. Atherosclerosis. 2010;211:437-444. Available from: https://doi.org/10.1016/j.atherosclerosis.2010.02.001
Dwivedi G, Liu Y, Tewari S, Inacio J, Pelletier-Galarneau M, Chow BJW. Incremental Prognostic Value of Quantified Vulnerable Plaque by Cardiac Computed Tomography. J Thorac Imaging. 2016;31:373-379. Available from: https://doi.org/10.1097/rti.0000000000000236
Glagov S, Weisenberg E, Zarins CK, Stankunavicius R, Kolettis GJ. Compensatory enlargement of human atherosclerotic coronary arteries. N Engl J Med. 1987;316:1371-1375. Available from: https://doi.org/10.1056/nejm198705283162204