Atherosclerotic Plaque Comparison of Coronary and Peripheral Arteries

Paul D. Bishop, MSEE, Kenneth Ouriel, MD, Vikram S. Kashyap, MD, Sean P. Nassoiy, BS, Mircea L. Pavkov, MD, Ashleigh T. Clair, BS, Anuja Nair, PhD, Geoff Vince, PhD, James F. Bena, MS, Daniel G. Clair, MD.
Cleveland Clinic, Cleveland, OH, USA.

Objective: The aim of this study was to evaluate peripheral and coronary arterial plaque composition and determine if significant plaque composition differences exist.
Methods: Twenty-two patients with atherosclerotic peripheral arteries underwent intravascular ultrasound (IVUS) evaluation of the peripheral arteries as part of an angiogram for peripheral arterial disease (PAD). Coronary artery specimens with atherosclerotic lesions from an additional fourteen cadavers were obtained within twenty-four hours of demise and IVUS imaged ex vivo. Sequential IVUS data was obtained at known intervals throughout the vessel length for both artery types, and analyzed with radiofrequency techniques for quantification of plaque composition, plaque volume, and total vessel volume. Plaque composition was categorized as fibrous, fibro-fatty, necrotic core, and dense calcium. Two-sided t-tests were performed to compare components within each plaque. A significance level of 0.05 was assumed for each test. Results are expressed as mean percentage±SEM.
Results: Peripheral arteries had more dense calcium within these plaques than coronary arteries (9.76±1.34% v. 3.85±0.72%, P<0.001). The remaining three peripheral v. coronary plaque component results, fibrous (60.60±1.68% v. 62.17±1.88%, P=0.54), fibro-fatty (15.52±1.59% v. 18.46±3.28%, P=0.43) and necrotic-core (14.13±1.36% v. 15.52±2.40%, P=0.62), showed little difference between the two vessel types
Conclusion: Peripheral arteries are associated with higher levels of dense calcium plaque than coronary arteries. Fibrous, fibro-fatty, and necrotic core plaque components showed little difference in mean levels between peripheral and coronary arteries. These results may have important implications in choosing treatment modalities and in understanding the clinical course of atherosclerotic disease in different arterial beds.

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