The Dynamic Nature of Coronary Artery Lesion Morphology Assessed by Serial Virtual Histology Intravascular Ultrasound Tissue Characterization

Takashi Kubo, Akiko Maehara, Gary S. Mintz, Hiroshi Doi, Kenichi Tsujita, So Yeon Choi, Osamu Katoh, Kenya Nasu, Andreas Koenig, Michael Pieper, Jason H Rogers, William Wijns, Dirk Böse, M. Pauliina Margolis, Jeffrey W. Moses, Gregg W. Stone, Martin B. Leon

Research output: Contribution to journalArticlepeer-review

253 Scopus citations


Objectives: We used virtual histology intravascular ultrasound (VH-IVUS) to investigate the natural history of coronary artery lesion morphology. Background: Plaque stability is related to its histological composition. Methods: We performed serial (baseline and 12-month follow-up) VH-IVUS studies and examined 216 nonculprit lesions (plaque burden ≥40%) in 99 patients. Lesions were classified into pathological intimal thickening (PIT), VH-IVUS-derived thin-capped fibroatheroma (VH-TCFA), thick-capped fibroatheroma (ThCFA), fibrotic plaque, and fibrocalcific plaque. Results: At baseline, 20 lesions were VH-TCFAs; during follow-up, 15 (75%) VH-TCFAs "healed," 13 became ThCFAs, 2 became fibrotic plaque, and 5 (25%) VH-TCFAs remained unchanged. Compared with VH-TCFAs that healed, VH-TCFAs that remained VH-TCFAs located more proximally (values are median [interquartile range]) (16 mm [15 to 18 mm] vs. 31 mm [22 to 47 mm], p = 0.013) and had larger lumen (9.1 mm2 [8.2 to 10.7 mm2] vs. 6.9 mm2 [6.0 to 8.2 mm2], p = 0.021), vessel (18.7 mm2 [17.3 to 28.6 mm2] vs. 15.5 mm2 [13.3 to 16.6 mm2]; p = 0.010), and plaque (9.7 mm2 [9.6 to 15.7 mm2] vs. 8.4 mm2 [7 to 9.7 mm2], p = 0.027) areas; however, baseline VH-IVUS plaque composition did not differ between VH-TCFAs that healed and VH-TCFAs that remained VH-TCFAs. Conversely, 12 new VH-TCFAs developed; 6 late-developing VH-TCFAs were PITs, and 6 were ThCFAs at baseline. In addition, plaque area at minimum lumen sites increased significantly in PITs (7.8 mm2 [6.2 to 10.0 mm2] to 9.0 mm2 [6.5 to 12.0 mm2], p < 0.001), VH-TCFAs (8.6 mm2 [7.3 to 9.9 mm2] to 9.5 mm2 [7.8 to 10.8 mm2], p = 0.024), and ThCFAs (8.6 mm2 [6.8 to 10.2 mm2] to 8.8 mm2 [7.1 to 11.4 mm2], p < 0.001) with a corresponding decrease lumen areas, but not in fibrous or fibrocalcific plaque. Conclusions: Most VH-TCFAs healed during 12-month follow-up, whereas new VH-TCFAs also developed. PITs, VH-TCFAs, and ThCFAs showed significant plaque progression compared with fibrous and fibrocalcific plaque.

Original languageEnglish (US)
Pages (from-to)1590-1597
Number of pages8
JournalJournal of the American College of Cardiology
Issue number15
StatePublished - Apr 13 2010


  • atherosclerosis
  • coronary disease
  • intravascular ultrasound
  • virtual histology

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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