In vivo detection of vasa vasorum neovascularization using intravascular ultrasound: a comparison between acute coronary syndrome and stable angina pectoris

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Background: Previous animal experiments as well as pathological studies have suggested that vasa vasorum (VV) neovascularization may be related to coronary plaque progression and vulnerability. Purpose: The purpose of this study was to assess feasibility of intravascular ultrasound (IVUS) to detect VV and to compare VV between acute coronary syndrome (ACS) and stable angina pectoris (SAP). Methods: A total of 130 patients with left anterior descending coronary artery disease (75 ACS and 55 SAP) who underwent percutaneous coronary intervention were studied. IVUS pullback imaging was performed before intervention. VV was defined as a small (<1mm) tubular or vesicular, low-echoic structures observed exterior to media (Figure). Maximal number of the VV within a single cross section was compared between ACS and SAP. Remodeling index was calculated as lesion divided by the reference vessel area. Results: IVUS imaging was feasible to detect VV in 124 of 130 culprit lesions (95%). Fatty/Fibrofatty plaque was more frequently observed in the culprit lesions for ACS than those for SAP (49% vs. 31%, p=0.003). Maximal number of the VV was significantly higher in the culprit lesions for ACS than those for SAP (2.8±1.3 vs. 1.8±1.0, p<0.001). Vasa vasorum detected by IVUS Conclusions: IVUS imaging is feasible to detect VV. VV was more frequently observed at the culprit lesions for ACS than those for SAP, supporting its relation with plaque vulnerability.

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