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Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,632
Online ISSN 1827-191X
Fuchs M. 1, Heider P. 1, Pelisek J. 1, Poppert H. 2, Eckstein H.-H. 1
1 Department of Vascular and Endovascular Surgery;
2 Department of Neurology, Klinikum rechts der Isar der Technischen Universitaet Muenchen Munich, Germany
Aim: The purpose of this study was to evaluate the accuracy of carotid plaque characterisation by virtual histology using intravascular ultrasonography (VH-IVUS) by comparing the results with real morphology.
Methods: Following elective carotid endarterectomy (CEA), atherosclerotic plaques from 36 patients (19 asymptomatic, 17 symptomatic) underwent ex-vivo VH-IVUS examination. Afterwards, tissue specimens were fixed with formalin and embedded in paraffin. Atherosclerotic lesions were characterised following hematoxylin/eosin (HE) and Elastin van Gieson (EvG) staining using AHA classification (stages I to VIII). The plaque composition, cellularity, severity of inflammation, and atheroma-associated macrophages and foam cells were compared with virtual histology.
Results: Patients with symptomatic carotid artery stenosis showed most commonly lesion type IV-V (N.=9; 52.9%), followed by type VI (N.=3; 17.6%) and type VII (N.=3, 17.6%), type VIII (N.=1; 5.9%) and type I-III (N.=1; 5.9%). In asymptomatic patients with the main lesion was type VII (N.=8; 42.1%), followed by type I-III (N.=4; 21.1%), type IV-V (N.=3, 15.8%) and type VIII (N.=1; 5.3%). The composition of unstable lesions differed significantly in symptomatic patients compared to asymptomatic subjects (70.1% vs. 31.6%, P=0.03). The concordance between the histological results and the VH-IVUS classification was 86.1% (Cohen`s kappa of 0.72).
Conclusion: In the present study, our findings demonstrated significant correlation between true plaque composition determined by histology and VH-IVUS. Thus, IVUS might be useful as an additional diagnostic method to detect patients with unstable rupture-prone plaques.