Optical Coherence Tomography (OCT)
Negative and positive remodeling of coronary plaque.[1]
Outcomes of the PROSPECT Trial (Virtual Histology using IVUS).[2]
- OCT has the resolution needed to determine culprit lesions[3].
- Clues[3]:
- Plaque erosion
- Thrombus
Determining vulnerable plaque
- Being able to predict which lesions will rupture provides some clinical utility
- Characteristics which can be used to predict plaque vulnerability include[4]:
- Remodeling characteristics
- Positive remodeling: remodeling index > 1.05
- Minimal luminal area (MLA) < 4.0 mm2.
- Virtual histology: plaque burden > 70%
- Fibrous cap thickness: thin-cap fibroatheroma (TCFA)
- Remodeling characteristics
- Remodeling characteristics: positive remodeling is associated with a more "unstable" lesion when compared to negative remodeling[1].
- PROSPECT Trial (patients with ACS who had IVUS performed in multiple vessels)[5]:
- TCFA was associated with a statistically significant higher adverse event rate compared to the absence of TCFA
- TCFA + MLA < 4 mm2 was associated with a higher adverse event rate compared to no TCFA and MLA > 4 mm2.
- TCFA + plaque burden > 70% was associated with a higher adverse event rate compared to no TCFA and plaque burden < 70%.
- TCFA + plaque burden > 70% + MLA < 4 mm2 was associated with a statistically significant adverse event rate when compared to no TCFA + plaque burden < 70% + MLA > 4.
