BACKGROUND: Angiographic classifications of the location and severity of disease in the main vessel and side branch of coronary artery bifurcations have been proposed and applied to distal left main coronary artery (LMCA) bifurcation. METHODS AND RESULTS: We reviewed 140 angiograms of distal LMCA and ostial left anterior descending (LAD) and left circumflex (LCX) artery lesions with preintervention intravascular ultrasound (IVUS) of both the LAD and LCX arteries as well as the LMCA. Of 140 patients, 92.9% had at least 1 cross section with > or =40% IVUS plaque burden versus 57.2% of patients with an angiographic diameter stenosis > or =50%. Contrary to angiographic classifications, IVUS showed that bifurcation disease was rarely focal and that both sides of the flow divider were always disease-free. Continuous plaque from the LMCA into the proximal LAD artery was seen in 90%, from the LMCA into the LCX artery in 66.4%, and from the LMCA into both the LAD and LCX arteries in 62%. Plaque localized to either the LAD or LCX ostium and not involving the distal LMCA was seen in only 9.3% of LAD arteries and 17.1% of LCX arteries. Plaque distribution was not influenced by the LAD/LCX angiographic angle, lesion severity, LMCA length, or remodeling. We proposed an IVUS classification for bifurcation lesions illustrating longitudinal and circumferential spatial plaque distribution. CONCLUSIONS: Angiographic classification of LMCA bifurcation lesions is rarely accurate. IVUS shows that the carina is always spared and that the disease is diffuse rather than focal.
BACKGROUND: Angiographic classifications of the location and severity of disease in the main vessel and side branch of coronary artery bifurcations have been proposed and applied to distal left main coronary artery (LMCA) bifurcation. METHODS AND RESULTS: We reviewed 140 angiograms of distal LMCA and ostial left anterior descending (LAD) and left circumflex (LCX) artery lesions with preintervention intravascular ultrasound (IVUS) of both the LAD and LCX arteries as well as the LMCA. Of 140 patients, 92.9% had at least 1 cross section with > or =40% IVUS plaque burden versus 57.2% of patients with an angiographic diameter stenosis > or =50%. Contrary to angiographic classifications, IVUS showed that bifurcation disease was rarely focal and that both sides of the flow divider were always disease-free. Continuous plaque from the LMCA into the proximal LAD artery was seen in 90%, from the LMCA into the LCX artery in 66.4%, and from the LMCA into both the LAD and LCX arteries in 62%. Plaque localized to either the LAD or LCX ostium and not involving the distal LMCA was seen in only 9.3% of LAD arteries and 17.1% of LCX arteries. Plaque distribution was not influenced by the LAD/LCX angiographic angle, lesion severity, LMCA length, or remodeling. We proposed an IVUS classification for bifurcation lesions illustrating longitudinal and circumferential spatial plaque distribution. CONCLUSIONS: Angiographic classification of LMCA bifurcation lesions is rarely accurate. IVUS shows that the carina is always spared and that the disease is diffuse rather than focal.
Authors: Catherine Pagiatakis; Jean-Claude Tardif; Philippe L L'Allier; Rosaire Mongrain Journal: Med Biol Eng Comput Date: 2017-05-13 Impact factor: 2.602
Authors: Giovanni Luigi De Maria; Luca Testa; Jose M de la Torre Hernandez; Dimitrios Terentes-Printzios; Maria Emfietzoglou; Roberto Scarsini; Francesco Bedogni; Ernest Spitzer; Adrian Banning Journal: PLoS One Date: 2022-01-07 Impact factor: 3.240
Authors: Roxy Senior; Harmony R Reynolds; James K Min; Daniel S Berman; Michael H Picard; Bernard R Chaitman; Leslee J Shaw; Courtney B Page; Sajeev C Govindan; Jose Lopez-Sendon; Jesus Peteiro; Gurpreet S Wander; Jaroslaw Drozdz; Jose Marin-Neto; Joseph B Selvanayagam; Jonathan D Newman; Christophe Thuaire; Johann Christopher; James J Jang; Raymond Y Kwong; Sripal Bangalore; Gregg W Stone; Sean M O'Brien; William E Boden; David J Maron; Judith S Hochman Journal: J Am Coll Cardiol Date: 2022-02-22 Impact factor: 24.094