Screening of ruptured plaques in patients with coronary artery disease by intravascular ultrasound

Aim - To visualise the characteristics of ruptured plaques by intravascular ultrasound (IVUS) and to correlate plaque characteristiCS with clinical symptoms to establish a quantitative index of plaque vulnerability. Methods - 144 consecutive patients with angina-were examined using IVUS. Ruptured plaques, characterised by a plaque cavity and a tear on the thin fibrous cap, were identified in 31 patients (group A), of whom 23 (74%) presented with unstable angina. Plaque rupture was confirmed by injecting contrast medium filling the plaque cavity during IVUS examination. Of the patients without plaque rupture (group B, n = 108), only 19 (18%) had unstable angina. Results - No significant differences were found between groups A and B in relation to plaque and vessel area (p > 0.05). Mean (SD) per cent stenosis in group A was less than in group B, at 56.2 (16.5)% υ 67.9 (13.4)%; p < 0.001. Area of the emptied plaque cavity in group A (4.1 (3.2) mm²) was larger than the echolucent zone in group B (1.32 (0.79) mm²) (p < 0.001). The plaque cavity to plaque ratio in group A (38.5 (17.1)%) was larger than the echolucent area to plaque ratio in group B (11.2 (8.9)%) (p < 0.001). The thickness of the fibrous cap in group A was less than in group B, at 0.47 (0.20) mm υ 0.96 (0.94) mm; p < 0.001. Conclusions - Plaques seem to be prone to rupture when the echolucent area is larger than 4.1 (3.2) mm², when the echolucent area to plaque ratio is greater than 38.5 (17.1)%, and when the fibrous cap is thinner than 0.7 Mm. IVUS can identify plaque rupture and vulnerable plaques. This may influence patient management and treatment.