ORIGINAL ARTICLE  VASCULAR SURGERY 

The Journal of Cardiovascular Surgery 2017 February;58(1):55-64

DOI: 10.23736/S0021-9509.16.07655-2

Copyright © 2016 EDIZIONI MINERVA MEDICA

language: English

Ex vivo characterization of carotid plaques by intravascular ultrasonography and virtual histology: concordance with real plaque pathomorphology

Martina FUCHS ¹, Peter HEIDER ¹, Jaroslav PELISEK ¹, Holger POPPERT ², Henning H. ECKSTEIN ¹ ✉

¹ Department of Vascular and Endovascular Surgery, Klinikum Rechts der Isar der Technischen Universitaet Muenchen, Munich, Germany; ² Department of Neurology, Klinikum Rechts der Isar der Technischen Universitaet Muenchen, Munich, Germany

BACKGROUND: 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).
CONCLUSIONS: 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.

KEY WORDS: Diagnostic imaging - Atherosclerosis - Carotid stenosis