Angioscopic Evaluation of Ruptured Aortic Plaques

Study Questions:

What are the incidence, types, and dimensions of spontaneous ruptured aortic plaques (SRAPs) using angioscopy?

Methods:

The investigators conducted a cross-sectional study of 324 consecutive patients diagnosed with or suspected of having coronary artery disease, and subjected them to intra-aortic scans with nonobstructive angioscopy. Samples of SRAP were taken from the aorta. The dimensions of cholesterol crystals of atheromatous materials were measured with a polarizing microscope and compared with those of the ghost images of cholesterol crystals. Multivariate stepwise regression analysis was performed to explore the association between the total number of total SRAP and patient characteristics, and the association between SRAP at each section and patient characteristics.

Results:

SRAPs were detected in 262 patients (80.9%); 120 of 262 patients had ruptured aortic plaques below the diaphragmatic level. Samples were successfully obtained from 96 patients. The detected numbers of atheromatous material, fibrin, macrophage, and calcification were 237 (49.1%), 244 (50.6%), 111 (23.0%), and 127 (26.3%) out of 482 samples, respectively. The median lengths and widths of the sampled plaques were 254 µm (interquartile range [IQR], 100-685 µm) and 148 µm (IQR, 535-423.5 µm), respectively. The lengths and widths of the cholesterol crystals isolated from atheromatous materials were 40 mm (IQR, 32.7-53.7 µm) and 30 µm (IQR, 23-38 µm), respectively, compared with the respective dimensions of the ghost images of 86 mm (IQR, 53-119) and 13 µm (IQR, 7-18 µm). No embolic symptoms were observed within 24 hours of general care via cardiac catheterization.

Conclusions:

The authors concluded that SRAPs are commonly scattered, and their dimensions were smaller than previously recognized.

Perspective:

This cross-sectional study reports that asymptomatic and spontaneous aortic plaque rupture was detected in 80% of patients diagnosed with or suspected of coronary artery disease. This suggests that the daily or lifetime amount of debris might be quite abundant. Furthermore, asymptomatic subclinical accumulation plaque embolism might cause gradual asymptomatic deterioration of organ function, including dementia. Additional research is indicated to characterize the types and sizes of spontaneously ruptured aortic plaques that are most prone to atheroembolism, and to elucidate the pathogenesis and optimum management of patients with this form of aortic disease including the role of potent lipid-lowering therapies.

Clinical Topics: Cardiac Surgery, Dyslipidemia, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), Aortic Surgery, Cardiac Surgery and Arrhythmias, Lipid Metabolism, Nonstatins, Interventions and Coronary Artery Disease, Interventions and Imaging, Interventions and Vascular Medicine

Keywords: Angioscopes, Angioscopy, Aortic Diseases, Cardiac Catheterization, Cholesterol, Coronary Artery Disease, Diagnostic Imaging, Embolism, Cholesterol, Fibrin, Lipids, Macrophages, Plaque, Atherosclerotic, Primary Prevention, Vascular Diseases


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