Author + information
- Received August 25, 2010
- Revision received November 17, 2010
- Accepted February 4, 2011
- Published online June 1, 2011.
- Periklis Davlouros, MD, PhD⁎ (, )
- Anastasia Damelou, MD,
- Vasileios Karantalis, MD,
- Ioanna Xanthopoulou, MD,
- Eleni Mavronasiou, MD,
- Grigorios Tsigkas, MD,
- George Hahalis, MD, PhD and
- Dimitrios Alexopoulos, MD, PhD
- ↵⁎Reprint requests and correspondence:
Dr. Periklis A. Davlouros, Cardiology Department, Patras University Hospital, P. O. Box 26500 RION, Rion 26504, Greece
Objectives This study sought to assess, with optical coherence tomography (OCT), presumably culprit atherosclerotic lesions of saphenous vein grafts (SVGs) in patients with acute coronary syndromes (ACS).
Background Atherosclerotic lesions of SVGs have been studied in vivo with angioscopy and intravascular ultrasound. However, imaging with OCT, which has a higher resolution than intravascular ultrasound and better penetration than angioscopy, has not been conducted systematically.
Methods Using a nonocclusive OCT technique, we performed angiography and OCT of culprit SVG lesions in patients with unstable angina (UA), ST-segment elevation myocardial infarction (STEMI), and non-STEMI. Fibrous and fatty tissue, calcification, thrombus, and plaque rupture were defined according to OCT objective criteria.
Results Twenty-eight SVGs (average age 14.6 years) in 26 patients were imaged. Lesions on angiography were complex (96.4%), with ulceration in 32.1% and thrombus in 21.4%. OCT disclosed a fibrofatty composition in all lesions, calcification in 32.1%, plaque rupture in 60.7%, and thrombus in 46.4%. Thrombus was progressively more frequent across groups (UA to STEMI, p = 0.003; UA vs. myocardial infarction, p = 0.006). A thin fibrous cap was marginally more frequent in myocardial infarction patients (UA vs. myocardial infarction, p = 0.06; STEMI 100% vs. non-STEMI 53.3% vs. UA 20%, p = 0.03). OCT features of friability were present in 67.9% of SVGs not correlating with clinical presentation.
Conclusions OCT of culprit lesions of old SVGs in patients with ACS demonstrates fibrofatty composition, relatively thin fibrous cap, plaque rupture, and thrombus, which correlate with the clinical spectrum of ACS. This suggests that similar mechanisms with native vessels' atherosclerosis may be involved in SVG-related ACS.
The authors have reported that they have no relationships to disclose.
- Received August 25, 2010.
- Revision received November 17, 2010.
- Accepted February 4, 2011.
- American College of Cardiology Foundation