Association between carotid and coronary atherosclerotic plaque morphology: a virtual histology intravascular ultrasound study
Background: Atherosclerosis is considered to be a systemic disease, however, evidence exists on the heterogeneous nature of atherosclerotic disease. To date, continuous research seeks to determine the morphological differences between carotid and coronary artery disease.
Aim: This study aimed to evaluate the relationship of morphological characteristics assessed by VH-IVUS between carotid and coronary plaque composition among patients with and without history of cerebrovascular events.
Methods: This study was a single-center prospective study (n = 100; age 69.6±8.4). All patients were scheduled for carotid or coronary artery stenting and underwent virtual histology intravascular ultrasound (VH-IVUS) examination of the carotid and coronary arteries before intervention.
Results: There was a modest, but statistically significant correlation between the carotid and coronary necrotic core ([NC] r = 0.46, p < 0.01), fibro-fatty ([FF] r = 0.38, p < 0.01), dense calcium ([DC] r = 0.56, p < 0.01), and fibrous (r = 0.42, p < 0.01) plaque composition. High amount of necrotic core was detected in both arteries of carotid artery stenting (CAS) group with higher proportion in coronary artery (20.2% ± 9.4 vs 22.7% ± 6.8, p = 0.02). More fibrolipid content was observed in carotid plaque compared to coronary (19.6% ± 9.9 vs 12.2% ± 8.1, p <0.01). Patients with history of cerebrovascular events had a numerically greater proportion of necrotic tissue in carotid artery compared to asymptomatic and symptomatic CAS group patients (23.5% ± 10.7 vs 18.9% ± 8.2 and 18.7% ± 9.5, p = 0.11).
Conclusions: The percentage of all analyzed plaque components was moderately correlated between coronary and carotid artery plaques. Nevertheless, the proportion of NC plaque tissue was greater in the coronary arteries, while the carotid arteries showed more %FF atherosclerotic lesions. CAS group patients with a history of cerebrovascular events had a tendency of greater proportion of necrotic tissue in analyzed carotid plaques compared to others in the CAS group.
Relevance for Patients: In this study we found that patients with history of cerebrovascular event had a tendency of increased necrotic core content in culprit lesion of carotid artery. Complementary use of non-invasive and invasive imaging modalities allows to detect high risk atherosclerotic plaques and adjust treatment strategy.
[1] Shenouda R, Vancheri S, Bassi EM, Nicoll R, Sobhi M, El Sharkawy E, et al. The Relationship between Carotid and Coronary Calcification in Patients with Coronary Artery Disease. Clin Physiol Funct Imaging 2021;41:271-80.
[2] Cohen GI, Aboufakher R, Bess R, Frank J, Othman M, Doan D, et al. Relationship between Carotid Disease on Ultrasound and Coronary Disease on CT Angiography. JACC Cardiovasc Imaging 2013;6:1160-7.
[3] Den Ruijter HM, Peters SA, Anderson TJ, Britton AR, Dekker JM, Eijkemans MJ, et al. Common Carotid IntimaMedia Thickness Measurements in Cardiovascular Risk Prediction: A Meta-Analysis. JAMA 2012;308:796-803.
[4] Amato M, Montorsi P, Ravani A, Oldani E, Galli S, Ravagnani PM, et al. Carotid Intima-Media Thickness by B-Mode Ultrasound as Surrogate of Coronary Atherosclerosis: Correlation with Quantitative Coronary Angiography and Coronary Intravascular Ultrasound Findings. Eur Heart J 2007;28:2094-101.
[5] Nasu K, Tsuchikane E, Katoh O, Vince DG, Virmani R, Surmely JF, 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;47:2405-12.
[6] Virmani R, Burke AP, Farb A, Kolodgie FD. Pathology of the Vulnerable Plaque. J Am Coll Cardiol 2006;47(8 Suppl):C13-8.
[7] Stone GW, Maehara A, Lansky AJ, de Bruyne B, Cristea E, Mintz GS, et al. A Prospective Natural-History Study of Coronary Atherosclerosis. N Engl J Med 2011;364:226-35.
[8] Cheng JM, Garcia-Garcia HM, de Boer SP, Kardys I, Heo JH, Akkerhuis KM, et al. In Vivo Detection of HighRisk Coronary Plaques by Radiofrequency Intravascular Ultrasound and Cardiovascular Outcome: Results of the ATHEROREMO-IVUS Study. Eur Heart J 2014;35:639-47.
[9] Musialek P, Pieniazek P, Tracz W, Tekieli L, Przewlocki T, Kablak-Ziembicka A, et al. Safety of Embolic Protection Device-Assisted and Unprotected Intravascular Ultrasound in Evaluating Carotid Artery Atherosclerotic Lesions. Med Sci Monit 2012;18:MT7-18.
[10] Thim T, Hagensen MK, Bentzon JF, Falk E. From Vulnerable Plaque to Atherothrombosis. J Intern Med 2008;263:506-16.
[11] Stefanadis C, Antoniou CK, Tsiachris D, Pietri P. Coronary Atherosclerotic Vulnerable Plaque: Current Perspectives. J Am Heart Assoc 2017;6:e005543
[12] Samady H, Eshtehardi P, McDaniel MC, Suo J, Dhawan SS, Maynard C, et al. Coronary Artery Wall Shear Stress is Associated with Progression and Transformation of Atherosclerotic Plaque and Arterial Remodeling in Patients with Coronary Artery Disease. Circulation 2011;124:779-88.
[13] Eshtehardi P, McDaniel MC, Suo J, Dhawan SS, Timmins LH, Binongo JN, et al. Association of Coronary Wall Shear Stress with Atherosclerotic Plaque Burden, Composition, and Distribution in Patients with Coronary Artery Disease. J Am Heart Assoc 2012;1:e002543.
[14] Granada JF, Wallace-Bradley D, Win HK, Alviar CL, Builes A, Lev EI, et al. In Vivo Plaque Characterization using Intravascular Ultrasound-Virtual Histology in a Porcine Model of Complex Coronary Lesions. Arterioscler Thromb Vasc Biol 2007;27:387-93.
[15] Thim T, Hagensen MK, Wallace-Bradley D, Granada JF, Kaluza GL, Drouet L, et al. Unreliable Assessment of Necrotic Core by Virtual Histology Intravascular Ultrasound in Porcine Coronary Artery Disease. Circ Cardiovasc Imaging 2010;3:384-91.
[16] Diethrich EB, Margolis MP, Reid DB, Burke A, Ramaiah V, Rodriguez-Lopez JA, et al. Virtual Histology Intravascular Ultrasound Assessment of Carotid Artery Disease: The Carotid Artery Plaque Virtual Histology Evaluation (CAPITAL) Study. J Endovasc Ther 2007;14:676-86.
[17] Matsumoto S, Nakahara I, Higashi T, Iwamuro Y, Watanabe Y, Takezawa M, et al. Fibro-Fatty Volume of Culprit Lesions in Virtual Histology Intravascular Ultrasound is Associated with the Amount of Debris during Carotid Artery Stenting. Cerebrovasc Dis 2010;29: 468-75.
[18] Winston B, Siewiorek GM, Finol EA, Wholey M. A Case Series of Virtual Histology Intravascular Ultrasound in Carotid Artery Stenting. Vasc Dis Manage 2011;8:E144-50.
[19] Philipp S, Böse D, Wijns W, Marso SP, SchwartzRS, König A, et al. Do Systemic Risk Factors Impact Invasive Findings from Virtual Histology? Insights from the International Virtual Histology Registry. Eur Heart J 2010;31:196-202.
[20] Henein M, Granåsen G, Wiklund U, Schmermund A, Guerci A, Erbel R, et al. High Dose and Long-Term Statin Therapy Accelerate Coronary Artery Calcification. Int J Cardiol 2015;184:581-6.