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Background . Recent intravascular ultrasound (IVUS) studies have demonstrated that hypoechoic plaque with deep ultrasound attenuation despite absence of bright calcium is common in acute coronary syndrome. Such “attenuated plaque” may be an IVUS characteristic of unstable lesion.   Methods . We used optical coherence tomography (OCT) in 104 patients with unstable angina to compare lesion characteristics between IVUS-detected attenuated plaque and nonattenuated plaque.   Results . IVUS-detected attenuated plaque was observed in 41 (39%) patients. OCT-detected lipidic plaque (88% versus 49%,  P  < 0.001), thin-cap fibroatheroma (48% versus 16%,  P  < 0.001), plaque rupture (44% versus 11%,  P  < 0.001), and intracoronary thrombus (54% versus 17%,  P  < 0.001) were more often seen in IVUS-detected attenuated plaques compared with nonattenuated plaques.   Conclusions . IVUS-detected attenuated plaque has many characteristics of unstable coronary lesion. The presence of attended plaque might be an important marker of lesion instability.

Optical Coherence Tomography Analysis of Attenuated Plaques Detected by Intravascular Ultrasound in Patients with Acute Coronary Syndromes