Advertisement

The Virtual Histology Intravascular Ultrasound Appearance of Newly Placed Drug-Eluting Stents

      Intravascular ultrasound (IVUS) is used before and after intervention and at follow-up to assess the quality of the acute result as well as the long-term effects of stent implantation. Virtual histology (VH) IVUS classifies tissue into fibrous and fibrofatty plaque, dense calcium, and necrotic core. Although most interventional procedures include stent implantation, VH IVUS classification of stent metal has not been validated. In this study, the VH IVUS appearance of acutely implanted stents was assessed in 27 patients (30 lesions). Most stent struts (80%) appeared white (misclassified as “calcium”) surrounded by red (misclassified as “necrotic core”); 2% appeared just white, and 17% were not detectable (compared with grayscale IVUS because of the software-imposed gray medial stripe). The rate of “white surrounded by red” was similar over the lengths of the stents; however, undetectable struts were mostly at the distal edges (31%). Quantitatively, including the struts within the regions of interest increased the amount of “calcium” from 0.23 ± 0.35 to 1.07 ± 0.66 mm2 (p <0.0001) and the amount of “necrotic core” from 0.59 ± 0.65 to 1.31 ± 0.87 mm2 (p <0.0001). Most important, because this appearance occurs acutely, it is an artifact, and the red appearance should not be interpreted as peristrut inflammation or necrotic core when it is seen at follow-up. In conclusion, acutely implanted stents have an appearance that can be misclassified by VH IVUS as “calcium with or without necrotic core.” It is important not to overinterpret VH IVUS studies of chronically implanted stents when this appearance is observed at follow-up. A separate classification for stent struts is necessary to avoid these misconceptions and misclassifications.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Nair A.
        • Kuban B.D.
        • Tuzcu E.M.
        • Schoenhagen P.
        • Nissen S.E.
        • Vince D.G.
        Coronary plaque classification with intravascular ultrasound radiofrequency data analysis.
        Circulation. 2002; 106: 2200-2206
        • Nair A.
        • Calvetti D.
        • Vince D.G.
        Regularized autoregressive analysis of intravascular ultrasound backscatter: improvement in spatial accuracy of tissue maps.
        IEEE Trans Ultrason Ferroelectr Freq Control. 2004; 51: 420-431
        • Fujii K.
        • Carlier S.G.
        • Mintz G.S.
        • Wijns W.
        • Colombo A.
        • Böse D.
        • Erbel R.
        • de Ribamar Costa Jr, J.
        • Kimura M.
        • et al.
        Association of plaque characterization by intravascular ultrasound virtual histology and arterial remodeling.
        Am J Cardiol. 2005; 96: 1476-1483
        • Nasu K.
        • Tsuchikane E.
        • Katoh O.
        • Vince D.G.
        • Virmani R.
        • Surmely J.F.
        • Murata A.
        • Takeda Y.
        • Ito T.
        • Ehara M.
        • et al.
        Accuracy of in vivo coronary plaque morphology assessment: a validation study of in vivo virtual histology compared with in vitro histopathology.
        J Am Coll Cardiol. 2006; 47: 2405-2412
        • Mintz G.S.
        • Nissen S.E.
        • Anderson W.D.
        • Bailey S.R.
        • Erbel R.
        • Fitzgerald P.J.
        • Pinto F.J.
        • Rosenfield K.
        • Siegel R.J.
        • Tuzcu E.M.
        • Yock P.G.
        American College of Cardiology clinical expert consensus document on standards for acquisition, measurement and reporting of intravascular ultrasound studies (IVUS).
        J Am Coll Cardiol. 2001; 37: 1478-1492
        • Rodriguez-Granillo G.A.
        • McFadden E.P.
        • Valgimigli M.
        • van Mieghem C.A.
        • Regar E.
        • de Feyter P.J.
        • Serruys P.W.
        Coronary plaque composition of nonculprit lesions, assessed by in vivo intracoronary ultrasound radio frequency data analysis, is related to clinical presentation.
        Am Heart J. 2006; 151: 1020-1024
        • Hong M.K.
        • Mintz G.S.
        • Lee C.W.
        • Suh J.
        • Kim J.H.
        • Park D.W.
        • Lee S.W.
        • Kim Y.H.
        • Cheong S.S.
        • Kim J.J.
        • et al.
        Comparison of virtual histology to intravascular ultrasound of culprit coronary lesions in acute coronary syndrome and target coronary lesions in stable angina pectoris.
        Am J Cardiol. 2007; 100: 953-959
        • Valgimigli M.
        • Rodriguez-Granillo G.A.
        • Garcia-Garcia H.M.
        • Vaina S.
        • De Jaegere P.
        • De Feyter P.
        • Serruys P.W.
        Plaque composition in the left main stem mimics the distal but not the proximal tract of the left coronary artery: influence of clinical presentation, length of the left main trunk, lipid profile, and systemic levels of C-reactive protein.
        J Am Coll Cardiol. 2007; 49: 23-31
        • Valgimigli M.
        • Rodriguez-Granillo G.A.
        • Garcia-Garcia H.M.
        • Malagutti P.
        • Regar E.
        • de Jaegere P.
        • de Feyter P.
        • Serruys P.W.
        Distance from the ostium as an independent determinant of coronary plaque composition in vivo: an intravascular ultrasound study based radiofrequency data analysis in humans.
        Eur Heart J. 2006; 27: 655-663
        • Rodriguez-Granillo G.A.
        • Garcia-Garcia H.M.
        • Valgimigli M.
        • Vaina S.
        • van Mieghem C.
        • van Geuns R.J.
        • van der Ent M.
        • Regar E.
        • de Jaegere P.
        • van der Giessen W.
        • et al.
        Global characterization of coronary plaque rupture phenotype using three-vessel intravascular ultrasound radiofrequency data analysis.
        Eur Heart J. 2006; 27: 1921-1927
        • Rodriguez-Granillo G.A.
        • Garcia-Garcia H.M.
        • Mc Fadden E.P.
        • Valgimigli M.
        • Aoki J.
        • de Feyter P.
        • Serruys P.W.
        In vivo intravascular ultrasound-derived thin-cap fibroatheroma detection using ultrasound radiofrequency data analysis.
        J Am Coll Cardiol. 2005; 46: 2038-2042