In Vivo Assessment of High-Risk Coronary Plaques at Bifurcations With Combined Intravascular Ultrasound and Optical Coherence Tomography

Objectives: This study sought to evaluate the in vivo frequency and distribution of high-risk plaques (i.e., necrotic core rich) at bifurcations using a combined plaque assessment with intravascular ultrasound-virtual histology (IVUS-VH) and optical coherence tomography (OCT). Background: Pathological examinations have shown that atherosclerotic plaque rich in necrotic core is prone to develop at bifurcations. High-risk plaque detection could be improved by the combined use of a technique able to detect necrotic core (IVUS-VH) and a high-resolution technique that allows the measurement of the fibrous cap thickness (OCT). Methods: From 30 patients imaged with IVUS-VH and OCT, 103 bifurcations were selected. The main branch was analyzed at the proximal rim of the ostium of the side branch, at the in-bifurcation segment and at the distal rim of the ostium of the side branch. Plaques with more than 10% confluent necrotic core by IVUS-VH were selected and classified as fibroatheroma (FA) or thin-cap fibroatheroma (TCFA) depending on the thickness of the fibrous cap by OCT (>65 or ≤65 μm for FA and TCFA, respectively). Results: Twenty-seven FA (26.2%) and 18 TCFA (17.4%) were found out of the 103 lesions studied. Overall the percentage of necrotic core decreases from proximal to distal rim (16.8% vs. 13.5% respectively, p = 0.01), whereas the cap thickness showed an inverse tendency (130 ± 105 μm vs. 151 ± 68 μm for proximal and distal rim, respectively, p = 0.05). The thin caps were more often located in the proximal rim (15 of 34, 44.1%), followed by the in-bifurcation segment (14 of 34, 41.2%), and were less frequent in the distal rim (5 of 34, 14.7%). Conclusions: The proximal rim of the ostium of the side branch has been identified as a region more likely to contain thin fibrous cap and a greater proportion of necrotic core.