Korean Circ J.  2015 Jul;45(4):259-265. 10.4070/kcj.2015.45.4.259.

Roles of Intravascular Ultrasound in Patients with Acute Myocardial Infarction

• Hong YJ
• Ahn Y
• Jeong MH

• KMID: 1964096
• DOI: http://doi.org/10.4070/kcj.2015.45.4.259

Abstract

Rupture of a vulnerable plaque and subsequent thrombus formation are important mechanisms leading to the development of an acute myocardial infarction (AMI). Typical intravascular ultrasound (IVUS) features of AMI include plaque rupture, thrombus, positive remodeling, attenuated plaque, spotty calcification, and thin-cap fibroatheroma. No-reflow phenomenon was attributable to the embolization of thrombus and plaque debris that results from mechanical fragmentation of the vulnerable plaque by percutaneous coronary intervention (PCI). Several grayscale IVUS features including plaque rupture, thrombus, positive remodeling, greater plaque burden, decreased post-PCI plaque volume, and tissue prolapse, and virtual histology-IVUS features such as large necrotic corecontaining lesion and thin-cap fibroatheroma were the independent predictors of no-reflow phenomenon in AMI patients. Non-culprit lesions associated with recurrent events were more likely than those not associated with recurrent events to be characterized by a plaque burden of > or =70%, a minimal luminal area of < or =4.0 mm2, or to be classified as thin-cap fibroatheromas.

Keyword

Myocardial infarction; Atherosclerosis; Ultrasonography, interventional

MeSH Terms

Atherosclerosis
Humans
Myocardial Infarction*
No-Reflow Phenomenon
Percutaneous Coronary Intervention
Phenobarbital
Plaque, Atherosclerotic
Prolapse
Rupture
Thrombosis
Ultrasonography*
Ultrasonography, Interventional
Phenobarbital

Figure

• 

  Fig. 1 Intravascular ultrasound findings in patients with acute myocardial infarction. (A) Plaque rupture with a cavity that communicated with the lumen with an overlying residual fibrous cap fragment, (B) intracoronary thrombus shows a distinct hypoechoic mass, (C) positive remodeling with a remodeling index of 1.21, (D) attenuated plaque shows hypoechoic plaque with deep ultrasound attenuation without calcification or very dense fibrous plaque, (E) thin-cap fibroatheroma with a necrotic core of 35.4% of plaque area in the presence of 83.3% of plaque burden, and (F) tissue prolapse shows an intraluminal tissue extrusion through the stent struts.

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