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Virtual histology intravascular ultrasound comparison of coronary chronic total occlusions versus non-occlusive lesions

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Abstract

To use virtual histology intravascular ultrasound (VH-IVUS) to assess the differences in tissue composition between chronic total occlusions (CTO) and non-occlusive lesions, especially in vivo. We compared 50 CTOs (49 patients) after guidewire crossing with 41 non-occlusive lesions (41 patients, 25 with unstable angina and 16 with stable angina). Overall, the percentage of necrotic core in the CTO segments was similar to non-occlusive lesions (35.6 vs. 38.7 %, p = 0.18 at the maximum necrotic core site; 24.2 vs. 23.7 %, p = 0.8 in mean analysis over the entire segment length). However, the percentage of dense calcium in CTO segments was less than in non-occlusive lesions (10.6 vs. 14.8 %, p = 0.025 at the maximum necrotic core site; 7.6 vs. 11.4 %, p = 0.036 in mean analysis over the entire segment length). Finally, the necrotic core/dense calcium ratio tended to be larger in the CTO segment than in non-occlusive lesions (2.94 vs. 2.35, p = 0.082 at the maximum necrotic core site; 3.05 vs. 2.03, p = 0.005 in mean analysis over the entire segment length). Overall, 42 (84 %) CTOs contained a fibroatheroma compared to 40 (97 %) of non-occulsive stenoses. The percentage of necrotic core in CTOs with a fibroathroma (39.0 %) was less than non-occlusive stenoses with a VH-thin cap fibroathroma (44.4 %, p = 0.017) and greater than non-occlusive stenoses with a VH-thick cap fibroathroma (33.5 %, p = 0.022) at maximum necrotic core site. These findings suggest that the morphological characteristics of most CTOs were similar as compared with non-CTO lesions and CTOs evolved from fibroatheromas.

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Acknowledgments

Dr. Jun Guo, Dr Ning Guo, Dr. Shang, and Dr. Pu have received grant support from Boston Scientific Corporation, China. Dr. Maehara has received grant support from Boston Scientific Corporation and lecture fees from St. Jude Medical. Dr. Moses is a consultant for Boston Scientific Corporation and Cordis. Dr. Leon is on the advisory boards of Boston Scientific Corporation and Medtronic. Dr. Stone is a consultant to Volcano Corporation. Dr. Mintz has received grant support and is a consultant to Volcano Corporation and Boston Scientific Corporation.

Conflict of interest

Dr. Ochiai is on the speakers’ bureau of Boston Scientific Corporation. Dr. Ashida, Dr. Chirumamilla, Dr. Sanidas, and Dr. Weisz have nothing to disclose.

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Authors and Affiliations

  1. Columbia University Medical Center and the Cardiovascular Research Foundation, 111E 59th Street, New York, NY, 10022, USA

    Jun Guo, Akiko Maehara, Ning Guo, Amala Chirumamilla, Yunpeng Shang, Jun Pu, Elias Sanidas, Jeffrey W. Moses, Martin B. Leon, Giora Weisz, Gregg W. Stone & Gary S. Mintz

  2. Yokohama Shintoshi Neurosurgical Hospital, Yokohama, Japan

    Kazuhiro Ashida

  3. Showa University Northern Yokohama Hospital, Yokohama, Japan

    Masahiko Ochiai

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  1. Jun Guo
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  2. Akiko Maehara
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  3. Ning Guo
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  4. Kazuhiro Ashida
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  6. Yunpeng Shang
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  9. Jeffrey W. Moses
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  13. Gary S. Mintz
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Correspondence to Akiko Maehara.

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Guo, J., Maehara, A., Guo, N. et al. Virtual histology intravascular ultrasound comparison of coronary chronic total occlusions versus non-occlusive lesions. Int J Cardiovasc Imaging 29, 1249–1254 (2013). https://doi.org/10.1007/s10554-013-0222-x

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  • DOI: https://doi.org/10.1007/s10554-013-0222-x

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