IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY |
Virtual Histology of Aneurysmal Lesion in Aortocoronary Saphenous Vein Graft
Man-Hong Jim, MD,
Kai-Hang Yiu, MD1,
Ryan Lap-Yan Ko, MD1,
Chung-Wah Siu, MD1,
Wing-Hing Chow, MD
Cardiac Medical Unit Grantham Hospital, Hong Kong
1 Department of Medicine Queen Mary Hospital, Hong Kong
Man-Hong Jim, MD, Tel: +852 25182619, Fax: +852 25188558, Email: jimmanh2002{at}yahoo.com, Cardiac Medical Unit, Grantham Hospital, 125 Wong Chuk Road, Hong Kong, China.
A 68-year-old man who had undergone coronary artery bypass grafting 11 years earlier, presented with unstable angina. Angiography revealed diffuse atherosclerosis with critical stenoses in one of his saphenous vein grafts (Figure 1
). Virtual histology (Figure 2), an intravascular ultrasound study at the site of the positive remodeling (measuring 7.6 x 9.2 mm; see arrow in Figure 1) showed an eccentric plaque with a plaque burden of 86%, an excess of fibro-fatty (23%), and necrotic core tissue (21%). The heavy plaque load and lipid-rich composition probably account for the susceptibility to distal embolization during percutaneous revascularization.1 This is in keeping with the histological findings of cholesterol clefts and lipid-laden foam cells in the material captured by embolic protection devices.2
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Figure 1. Coronary angiography showing a tight lesion in the body of the saphenous vein graft, followed by a positively remodeled segment with a heavy atherosclerotic plaque load. The arrow marks the slice at which virtual histology was performed.
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Figure 2. Gray-scale image of an eccentric soft plaque within a large aneurysm (positive remodeling). The left panel is the corresponding virtual histology. Note the high level of fibro-fatty tissue (yellow) and necrotic core (red). The right panel is the longitudinal view showing eccentric abnormal bulging of the vessel wall.
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REFERENCES
- Hong MK, Mehran R, Dangas G, Mintz GS, Lansky AJ, Pichard AD, et al. Creatinine kinase-MB enzyme elevation following successful saphenous vein graft intervention is associated with late mortality. Circulation 1999;100:2400–5.[Abstract/Free Full Text]
- Webb JG, Carere RG, Virmani R, Baim D, Teirstein PS, Whitlow P, et al. Retrieval and analysis of particulate debris after saphenous vein graft intervention. J Am Coll Cardiol 1999;34:468–75.[Abstract/Free Full Text]
Asian Cardiovasc Thorac Ann 2009;
17:539-540
© 2009 by SAGE Publications
DOI: 10.1177/0218492309348630
