Intravascular ultrasound and angioscopy assessment of coronary plaque components in chronic totally occluded lesions

Shigeki Kimura, Tomoyo Sugiyama, Keiichi Hishikari, Shun Nakagama, Shun Nakamura, Toru Misawa, Masafumi Mizusawa, Kazuto Hayasaka, Yosuke Yamakami, Yuichiro Sagawa, Keisuke Kojima, Hirofumi Ohtani, Hiroyuki Hikita, Atsushi Takahashi

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)


Background: The in vivo lesion morphologies and plaque components of coronary chronic total occlusion (CTO) lesions remain unclear. Methods and Results: We investigated 57 consecutive CTO lesions in 57 patients with stable angina pectoris undergoing elective percutaneous coronary intervention with intravascular ultrasound (IVUS) and coronary angioscopy (CAS) examination. All CTO lesions were classified according to the proximal angiographic lumen pattern; tapered-type (T-CTO) and abrupt-type (A-CTO). The differences in the intracoronary images of these lesion types were evaluated according to the location within the CTO segment. A total of 35 lesions (61.4%) were T-CTO. T-CTO lesions had higher frequencies of red thrombi (proximal 71.4%; middle 74.3%; distal 31.4%; P<0.001) and bright-yellow plaques (yellow-grade 2–3) (48.6%; 74.3%; 2.9%; P<0.001) at the proximal or middle than at the distal subsegment; A-CTO lesions showed no significant differences among the 3 sub-segments. At the middle subsegment, T-CTO lesions showed higher frequencies of positive remodeling (51.4% vs. 18.2%, P=0.01) and bright-yellow plaques (74.3% vs. 13.6%, P<0.001) compared with A-CTO lesions. Multivariate analysis identified bright-yellow plaque as an independent predictor (odds ratio, 7.25; 95% confidence interval, 1.25–42.04; P=0.03) of the occurrence of periprocedural myocardial necrosis. Conclusions: The combination of IVUS and CAS analysis may be useful for identifying lesion morphology and plaque components, which may help clarify the pathogenetic mechanism of CTO lesions.

Original languageEnglish
Pages (from-to)2032-2040
Number of pages9
JournalCirculation Journal
Issue number8
Publication statusPublished - 2018
Externally publishedYes


  • Angioscopy
  • Atherosclerosis
  • Chronic total occlusion
  • Intravascular ultrasound
  • Troponin


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