THE RANDOMIZED STUDY OF PREVENTIVE REVASCULARIZATION OF VULNERABLE CORONARY ARTERY PLAQUES IN PATIENTS WITH STABLE CORONARY ARTERY DISEASE
Background. Today, treatment of vulnerable coronary artery plaques remain an issue of concern, including their preventive revascularization.. Aim. To evaluate the rationale for preventive revascularization of functionally insignificant vulnerable plaques according to the virtual-histology intravascular ultrasound in patients with stable coronary artery disease. Methods. Patients with stable coronary artery disease and isolated intermediate coronary stenosis are recruited in a prospective randomized study. First, fractional flow reserve is measured in all patients to confirm the presence of hemodynamically insignificant stenosis. Then, an intravascular ultrasound is performed to verify plaque vulnerability: a thin-cap fibroatheroma and / or minimum lumen area of <4 mm2 and/or plaque burden of >70%. After that, patients are randomized into two groups: preventive revascularization or optimal medical therapy. At 12 months follow-up, patients undergo repeated intravascular ultrasound and the endpoint analysis. Results. 10 patients have been included in the study (6 patients in the preventive revascularization group and 4 patients in the optimal medical therapy group). No endpoints and complications were recorded in both groups at 30-days follow-up. Conclusion. Intravascular imaging methods can identify vulnerable coronary plaques and promote a personalized approach in determining treatment strategy, including preventive revascularization.