Читать книгу Interventional Cardiology - Группа авторов - Страница 34

Calcified nodule, pathologically defined as, the presence of fracture of a calcified plate protruding into the lumen through a disrupted fibrous cap with an overlying thrombus (Figure 1.4), is the least frequent pathological finding associated with coronary thrombosis [115]. Consistent with the histological findings, clinical OCT evaluation in a study of 126 patients with ACS found a prevalence of 7.9%, with being more common in older patients [132]. Thus, given that the prevalence of plaque rupture and erosion are higher enough to get details compared with calcified nodule, it remains a poorly understood entity. In pathology series, calcified nodules are more commonly found in older individuals in the mid‐right coronary artery or left anterior descending artery where torsion is greatest [115]. Coronary calcification correlates highly with plaque burden and is an independent marker of cardiovascular risk [135]. Furthermore, coronary calcification within a thin fibrous cap can increase the circumferential stress leading to plaque rupture and thrombotic events [136]. OCT is the only tool to depict the thickness of superficial calcium deposits accurately, superior to IVUS [137]. Additionally, a great ability to detect calcified nodules have been reported with a sensitivity of 96% and specificity of 97% [138]. Recently, striking images showing a close correlation between pathological and OCT findings in a human coronary artery were reported [139]. However, more recent studies have raised an important issue with regard to the visualization of intense dorsal shadowing generated by protruding red thrombus and protruding bony calcified spicules [140,141]. Further investigation is required to clarify whether protruding luminal red thrombus emerged directly, or small bony calcified nodules generated intense dorsal shadowing.