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254 Sondore et al. | Journal of Clinical and Translational Research 2023; 9(4): 253-260
between carotid atherosclerotic changes and the extent and carotid artery imaging with IVUS in the absence of intervention [9],
severity of coronary artery disease (CAD) are well-known [1-4]. distal protection devices (Spider, EV3; Filter wire EZ, Boston
Virtual histology (VH) is an established technique that allows for Scientific; Emboshield, Abbott) were used.
the in vivo assessment of plaque composition [5]. As such, VH
intravascular ultrasound (VH-IVUS) provides information about 2.2. Statistical analysis
plaque features, such as necrotic core (NC) tissue, which among Continuous data are represented as mean ± standard
others characterize the so-called vulnerable plaque [6]. VH-IVUS deviation, whereas categorical data were expressed as
allows to assess coronary plaque composition and to detect thin numbers or frequencies of occurrence. For the categorical
cap fibroatheroma which, along with the degree of plaque burden, data analysis, we used a Chi-square test. For the continuous
is predictors of adverse outcome [7,8]. data, we first assessed normality using visual inspection of a
The aim of the present study was to evaluate the relationship normal probability plot and a formal test, the Shapiro–Wilk
of morphological characteristics assessed by VH-IVUS between test. Differences between carotid and coronary VH-IVUS
carotid and coronary plaque composition among patients with a findings were analyzed using a non-parametric related samples
history of cerebrovascular accidents and subjects without a prior test, the Wilcoxon signed-rank test, and a parametric paired
adverse event. samples t-test. Pearson’s correlations were used to assess the
2. Study Design relation between carotid and coronary atherosclerotic plaque
components. Two-way analysis of variance test was used to test
This was a single-center and cross-sectional study performed at for the main effects of each independent variable, as well as
the Latvian Center of Cardiology, Pauls Stradins Clinical University the interaction effect between them. All statistical analyses were
Hospital. Study participants were consecutive patients referred to performed using the IBM SPSS software package (IBM SPSS
the center with symptoms of ischemia (cerebral or cardiac) for Statistics 22.0, Chicago, IL, USA). P < 0.01 was considered to
invasive diagnosis of artery disease. After coronary/carotid artery indicate statistical significance.
angiography, patients were scheduled for percutaneous coronary 3. Results
intervention (PCI) or carotid artery stenting (CAS). Based on this
qualification, all patients were divided into two groups: The CAS A total of 100 patients were enrolled in this study, and VH-
and PCI group. Indications for this procedure in the CAS group IVUS examination was performed on the carotid and coronary
were stenosis ≥60% in the ipsilateral carotid artery in patients arteries. In the CAS group, the mean age between asymptomatic,
with current symptoms, a history of cerebrovascular event, or symptomatic, and with a history of cerebrovascular events
hemodynamically significant stenosis (≥75%) in asymptomatic patients varied from 67 to 69 years, and predominantly more
patients. In the PCI group, patients with hemodynamically men were present in each group. Furthermore, the SYNTAX
significant coronary artery narrowing were scheduled for PCI. score for each CAS subgroup is shown in Table 1. Overall,
All patients had atherosclerotic lesion with <50% narrowing in baseline clinical characteristics of the study population are
other vascular bed (non-culprit) and no other lesions requiring shown in Tables 1 and 2.
revascularization. Both, the culprit and non-culprit lesion, were Table 3 summarizes the VH-IVUS characteristics of the
selected for VH-IVUS analysis. The study included 78 patients analyzed carotid and coronary artery plaques in the CAS group.
who underwent CAS and 22 patients who underwent PCI. Patients Carotid arteries were larger according to the analyzed VH-IVUS
in the CAS group were categorized in asymptomatic, symptomatic, parameters and had a higher plaque burden and necrotic tissue
and history of cerebrovascular event subgroups. PCI group was percentage in analyzed arteries compared to coronary arteries.
divided into stable angina and asymptomatic patients. The study The analyzed segment length did not differ between the coronary
was approved by the Local Ethics Committee, and all subjects and carotid arteries (17.1 ± 9.9 mm and 15.8 ± 8.3 mm, P = 0.26).
provided informed written consent. Procedural and VH-IVUS characteristics of the PCI group are
2.1. VH shown in Table 4.
VH comparison between carotid and coronary arteries is shown
All patients underwent VH-IVUS examination of coronary in Table 5. The analyzed segment of the carotid artery had a lower
and carotid plaques. Under fluoroscopy, an IVUS catheter (Eagle percentage of necrotic tissue and calcium, but a significantly
Eye™; Volcano Therapeutics Inc.; CA, USA) was positioned in the higher percentage of fibrolipids. The percentage of fibrotic tissue
carotid artery and then in the coronary artery. The IVUS catheter did not differ among the analyzed vascular beds.
was pulled back at a continuous speed of 0.5 mm/s from the distal The analyzed segments showed moderately positive, statistically
part of the carotid or coronary artery. The length of the pullback significant correlations among the analyzed vascular beds – NC
segment varied according to plaque length. The pullback was (r = 0.46, P < 0.01), fibrotic tissue (r = 0.42, P < 0.01), fibro-
initiated 10–20 mm distal to the plaque and terminated 10–20 mm fatty tissue ([FF] r = 0.37, P < 0.01), and dense calcium tissue
proximal to the plaque. In the carotid artery, if a cerebral protection ([DC] r = 0.56, P < 0.01). The correlation between carotid and
device was used, the IVUS pullback catheter was positioned on the coronary plaque composition of all analyzed lesions is displayed
cerebral protection device wire. For CAS procedures, but not for in Figure 1.
DOI: http://dx.doi.org/10.18053/jctres.09.202304.23-00030