Stockholm, Sweden, 30 August: Through the use of virtual histology intravascular ultrasound (VH IVUS) and coronary computed tomography angiography (CTA) imaging techniques, research has demonstrated that the more dangerous plaques leading to coronary events tend to be located in the proximal part of the coronary arteries. This offers the promise that these lesions should be more accessible to local treatment options and more easily detected by non-invasive CTA.
At the Leiden University Medical Center, 168 patients reporting chest pain were evaluated by VH IVUS and CTA techniques. The purpose of the study was to gain more knowledge on the location of plaques in the coronary arteries. The researchers demonstrated that the more dangerous types of plaque were primarily located in the left anterior descending coronary artery (left coronary artery), particularly in the proximal part of the artery. Research lead, Doctor J. E. van Velzen of the Department of Cardiology at Leiden University Medical Center, summarised the results by noting that, “These findings strengthen the theory that the more dangerous plaques are located in particular regions. Also, plaques that are located proximally are more accessible to local invasive imaging techniques that aid identification, and to local treatment options such as percutaneous coronary intervention.”
Plaques have long been accepted as a contributory factor in coronary events. The rupture of a high-risk plaque, leading to an occlusion of a coronary artery, can result in a heart attack and even sudden cardiac death. Prior to this study, however, most data concerning the natural history and location of potentially high-risk plaques had been derived from retrospective autopsy studies. Interestingly, these studies demonstrated that the culprit lesions responsible for heart attacks are not uniformly distributed throughout the coronary artery tree, and tend to cluster within the proximal parts of the coronary arteries.
Two state-of-the-art imaging techniques were employed in this study to analyse the location of high-risk plaques. VH IVUS is an invasive catheter-based system that allows physicians to acquire images of diseased vessels from inside the artery. CTA, on the other hand, is non-invasive and has been demonstrated as a promising tool for assessment of coronary atherosclerotic plaques. Both techniques gave similar results and showed that almost half of high-risk plaques were located in the left anterior descending coronary artery and particularly in the proximal parts of the coronary arteries. However, high-risk plaque features were more uniformly distributed in the right coronary artery. The findings therefore support the theory that high-risk plaques have a focal location in the coronary artery tree and tend to be located in “hot spots”.
Reflecting on the study, Doctor van Velzen stated, “The results of this study are particularly relevant in the clinical setting, as they show how larger and more proximally located plaques can be easily detected by both invasive and non-invasive imaging techniques.”
Funding: Netherlands Heart Foundation (The Hague, Netherlands)
Contributors: Joëlla E. van Velzena,b, Joanne D. Schuijfa, Fleur R. de Graafa, Gabija Pundziutea, Fabrizio Spanóa, Martin J. Schalija, Lucia J. Kroftc, Albert de Roosc, Johannes H.C. Reiberc, J. Wouter Jukemaa,b, Ernst E. van der Walla,b, Jeroen J. Baxa
(aDepartment of Cardiology, Leiden University Medical Center, Leiden, the Netherlands, bThe Inter-university Cardiology Institute of the Netherlands, Utrecht, the Netherlands, cDepartment of Radiology, Leiden University Medical Center, Leiden, the Netherlands)