Relation Between Plaque Components and Plaque Prolapse After Drug-Eluting Stent Implantation - Virtual Histology-Intravascular Ultrasound

Abstract

Background: It is not well known which plaque components are associated with the development of plaque prolapse (PP) and what are the major components in prolapsed plaque. The relationship between pre-stenting plague components and post-stenting PP was assessed and the plaque components of prolapsed plaque were evaluated in patients who underwent drug-eluting stent (DES) implantation using virtual histology intravascular ultrasound (VH-IVUS). Methods and Results: The study group consisted of 132 patients who underwent DES implantation and pre- and post-stenting VH-IVUS. Of these patients, 68 patients had 76 PP lesions and 64 patients had 76 non-PP lesions. Intra-stent PP volume was 3.6 +/- 1.5 mm(3). Plague volume was significantly greater and absolute fibrotic (FT) and necrotic core (NC) volumes were significantly greater in PP lesions compared with non-PP lesions. On multivariate analysis, absolute NC (odds ratios [OR]=1.14, P<0.001) and FT volume (OR=1.09, P<0.001) were independently associated with the development of PP. In intra-stent prolapsed plaque the FT component was greatest, but the NC component was also large, and %NC volume correlated positively with Delta creatine kinase-MB (r=0.489, P<0.001) and Delta troponin-I (r=.0.679, P<0.001), and %FT volume correlated negatively with Delta CK-MB (r=-0.539, P<0.001) and Delta troponin-I. Conclusions: NC and FT components were associated with development of PP; and NC and FT components in prolapsed plaque were associated with cardiac enzyme elevation after DES implantation. (Circ J 2010; 74: 1142-1151)