Cardiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street | GRB 800 |, 02114, Boston, MA, USA.
Interventional Cardiology Unit, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba, 270-2232, Japan.
J Thromb Thrombolysis. 2023 Apr;55(3):432-438. doi: 10.1007/s11239-023-02788-9. Epub 2023 Mar 4.
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.
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.
Among 150 patients (52 with layered plaque; 98 non-layered plaque), total atheroma volume (183.3 mm[114.2 mm to 275.0 mm] vs. 119.3 mm[68.9 mm to 185.5 mm], 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).
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.
gov , NCT01110538, NCT03479723, UMIN000041692.
层状斑块是先前亚临床斑块不稳定和愈合的特征。斑块破裂后，血栓形成并有序排列，形成新的斑块，这可能导致斑块快速进行性进展。然而，层状斑块与斑块体积之间的关系尚未完全阐明。
纳入了因急性冠脉综合征（ACS）就诊并接受罪犯病变的术前光学相干断层扫描（OCT）和血管内超声（IVUS）检查的患者。采用 OCT 识别层状斑块，采用 IVUS 测量罪犯病变周围的斑块体积。
在 150 例患者（52 例有层状斑块；98 例无层状斑块）中，总动脉粥样硬化斑块体积（183.3mm[114.2mm 至 275.0mm]比 119.3mm[68.9mm 至 185.5mm]，p=0.004）、斑块体积百分比（PAV）（60.1%[54.7%至 60.1%]比 53.7%[46.8%至 60.6%]，p=0.001）和斑块负荷（86.5%[81.7%至 85.7%]比 82.6%[77.9%至 85.4%]）在有层状斑块的患者中明显大于无层状斑块的患者。当将层状斑块分为多层或单层时，多层斑块患者的 PAV 明显大于单层斑块患者（62.1%[56.8%至 67.8%]比 57.5%[48.9%至 60.1%]，p=0.017）。与无层状模式相比，层状斑块的脂质指数更大（1958.0[420.9 至 2502.9]比 597.2[169.1 至 1624.7]，p=0.014）。
与无层状斑块相比，层状斑块的斑块体积和脂质指数明显更大。这些结果表明，ACS 患者罪犯病变处的斑块破裂和随后的愈合过程显著促进了斑块的进展。
gov ，NCT01110538，NCT03479723，UMIN000041692。
