Background: Atherosclerotic cardiovascular diseases are the leading cause of death worldwide (30% of the mortalities).
Coronary atherosclerotic plaques are classified into stable and unstable. Unstable plaques increase the risk of acute coronary syndrome and early detection will help prevention. Evaluation of plaque vulnerability is done best by invasive intravascular ultrasound and so, this study aims to evaluate the possible use of non invacive CT for plaque characterization.
Aim of the work: Determine the role of multidetector CT in the assessment of plaque composition and configuration. This will improve risk stratification thus, decreasing the incidence of sudden death.
Patients and methods: This study included 46 patients with coronary atherosclerotic plaques. The most expansive or solitary lesion was selected for each patient.
Results: Forty-six atherosclerotic plaques were evaluated by multi-slice coronary CT; 30 patients were unstable clinically and 16were stable. Dyslipidemia was found in 40 patients while diabetes was found in 22 patients. 69.6% of the lesions were found in the proximal LAD. Most of unstable patients showed mixed plaques and soft plaques. In a stable group, most of the plaques were calcified. As for the attenuation pattern 18/46 of the plaque with heterogeneous attenuation were in the unstable clinical group. 28/46 of the plaques with homogenous attenuation were stable. Regarding the Napkin ring sign it was positive in 18/46 of the plaques and the 18 patients on follow up were found to be unstable.
All patients with spotty calcification proved to be unstable clinically.
Remodeling index, low hounse field unit and plaque burden were higher in the unstable group.. No association between stability and degree of stenosis.
Conclusion: A strong correlation between plaque characteristics and clinical presentation: Multislice coronary CT angiography detect high-risk plaque criteria.