Assessment of the histological characteristics of coronary arterial plaque with severe calcification

Teruyoshi Kume, Hiroyuki Okura, Takahiro Kawamoto, Takashi Akasaka, Eiji Toyota, Yoji Neishi, Nozomi Watanabe, Renan Sukmawan, Ryotaro Yamada, Yoshito Sadahira, Kiyoshi Yoshida

Research output: Contribution to journalArticlepeer-review

34 Citations (Scopus)


Background: Several studies have shown that rotational atherectomy (RA) is associated with higher rates of the slow-flow phenomenon and that ablated particles may be the possible cause. Intravascular ultrasound (IVUS) has an intrinsic limitation in assessing plaque morphology behind the calcification because of acoustic shadowing. Therefore, the purpose of this study was to investigate plaque characteristics behind severe calcification by histological examination. Methods and Results: One hundred eight coronary arterial segments from 40 human cadavers (24 males, 16 females, mean age 74±7 years) were examined. Serial images of IVUS were obtained and 18 severe calcified lesions were collected. Experienced observers quantitatively analyzed the lesions by computerized planimetry for fibrous, fibrofatty, calcification, and necrotic tissue area. Histologically, 15 of 18 severely calcified lesions (83%) had an extensive necrotic tissue containing large numbers of cholesterol crystals and microcalcifications; 16 of same 18 severely calcified lesions (89%) had fibrofatty tissue as well as calcification. The necrotic tissue occupied 14±13% and fibrofatty tissue occupied 13±11% of severely calcified lesions. Conclusion: Necrotic core and fibrofatty tissue components "hidden" behind calcification might cause emboli-induced thrombus formation and distal flow disturbance during RA.

Original languageEnglish
Pages (from-to)643-647
Number of pages5
JournalCirculation Journal
Issue number5
Publication statusPublished - 2007


  • Coronary arterial plaque
  • Intravascular ultrasound
  • Rotational atherectomy
  • Slow flow


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