MORPHOLOGIC COMPARISON OF ATHEROSCLEROTIC LESIONS IN NATIVE CORONARY-ARTERIES AND SAPHENOUS-VEIN GRAPHS WITH INTRACORONARY ANGIOSCOPY IN PATIENTS WITH UNSTABLE ANGINA

Background Coronary vein grafts develop accelerated atherosclerosis af ter aortocoronary bypass surgery. Previous pathologic studies have sug gested that the morphologic appearance of atherosclerotic lesions in s aphenous vein grafts may have subtle differences compared with those o f native coronary arteries and may be more prone to disruption and thr ombus formation. However, a comparative in vivo assessment of the angi oscopic morphology differences between these two types of vessels has not been reported previously We compared the angioscopic lesion morpho logy of native coronary arteries and saphenous vein grafts in patients with unstable angina. Methods and Results Percutaneous coronary angio scopy was performed in 60 consecutive patients with unstable angina. P laque color, texture, friability, and the presence of atherosclerotic plaque ulceration or intracoronary thrombus were noted in the culprit lesion. The culprit lesion was located in native coronary arteries in 42 (70%) patients and in a saphenous vein graft in 18 (30%) patients. There were no significant differences in age, sex, and coronary risk f actors including tobacco use, hypertension, hypercholesterolemia, or d iabetes mellitus between the two populations, There were also no signi ficant differences between the two groups in terms of plaque color, su rface texture, or the incidence of complex plaque morphology (plaque u lceration and intracoronary thrombosis). loosely adherent, friable pla que, detected by angioscopy, was absent in native coronary arteries an d was present in 44% of the saphenous vein grafts (p < 0.0001). Conclu sions The results of our angioscopic study indicate that other than a high incidence of plaque friability in vein grafts, the surface morpho logy of culprit lesions in unstable angina patients is quite similar f or saphenous vein grafts and native coronary arteries.