Plaque burden influences accurate classification of fibrous cap atheroma by in vivo optical coherence tomography in a porcine model of advanced coronary atherosclerosis

Christian B. Poulsen, Ryan M. Pedrigi, Nilesh Pareek, Ismail D. Kilic, Niels R. Holm, Jacob F. Bentzon, Hans Erik Bøtker, Erling Falk, Rob Krams, Ranil De Silva

Research output: Contribution to journalArticle

3 Scopus citations


Aims: In vivo validation of coronary optical coherence tomography (OCT) against histology and the effects of plaque burden (PB) on plaque classification remain unreported. We aimed to investigate this in a porcine model with human-like coronary atherosclerosis. Methods and results: Five female Yucatan D374Y-PCSK9 transgenic hypercholesterolaemic minipigs were implanted with a coronary shear-modifying stent to induce advanced atherosclerosis. OCT frames (n=201) were obtained 34 weeks after implantation. Coronary arteries were perfusion-fixed, serially sectioned and co-registered with OCT using a validated algorithm. Lesions were adjudicated using the Virmani classification and PB assessed from histology. OCT had a high sensitivity, but modest specificity (92.9% and 74.6%), for identifying fibrous cap atheroma (FCA). The reduced specificity for OCT was due to mis-classification of plaques with histologically defined pathological intimal thickening (PIT) as FCA (46.1% of the frames with histological PIT were misclassified). PIT lesions misclassified as FCA by OCT had a statistically higher PB than in other OCT frames (median 32.0% versus 13.4%; p<0.0001). Misclassification of PIT lesions by OCT occurred when PB exceeded approximately 20%. Conclusions: Compared with histology, in vivo OCT classification of FCA had high sensitivity but reduced specificity due to misclassification of PITs with high PB.

Original languageEnglish (US)
Pages (from-to)1129-1135
Number of pages7
Issue number10
Publication statusPublished - Nov 2018



  • Coronary artery disease
  • Optical coherence tomography
  • Preclinical research

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this