Plaque composition and morphologic characteristics in significant left main bifurcation disease; virtual histology intravascular ultrasound study. Issue 8 (December 2016)

• Record Type: Journal Article
• Authors: Chang, Mineok; Kang, Soo-Jin; Yoon, Sung-Han; Ahn, Jung-Min; Park, Duk-Woo; Lee, Seung-Whan; Kim, Young-Hak; Lee, Cheol Whan; Park, Seong-Wook; Nakazawa, Gaku; Mintz, Gary S.; Park, Seung-Jung
• Is Part Of: Coronary artery disease. Volume 27:Issue 8(2016:Dec.)
• Publication Date: 2016-12
• Subjects: left main coronary artery disease -- virtual histology intravascular ultrasound -- vulnerable plaque; Coronary heart disease -- Periodicals; Coronary Disease -- Indexes; Coronary Disease -- Periodicals; 616.123005
• DOI: 10.1097/MCA.0000000000000417
• Languages: English
• ISSNs: 0954-6928

Abstract

Abstract : Objectives: Although the left main coronary artery (LMCA) is clinically the most important site, little is known about the longitudinal plaque distribution and composition in the significant LMCA disease. Methods: Preprocedure virtual histology intravascular ultrasound data were analyzed in 120 patients with significant LMCA bifurcation lesions (angiographic diameter stenosis>50%) requiring revascularization. Plaque burden and percentage of necrotic core (%NC) at the minimal lumen area site and maximal %NC site were measured in four segments: proximal LMCA, distal LMCA, left anterior descending (LAD) ostium, and proximal LAD. Results: Angiographically, a significant LMCA and ostial LAD stenosis were observed in 89.2 and 81.7% of patients, respectively. At the minimal lumen area site, the proximal LAD segment showed the smallest lumen [3.5 mm 2 (2.5–4.7), P <0.001] and the greatest plaque burden [73.2% (63.0–79.3), P <0.001] compared with the other segments. Also, there was a significant downward trend in the number of IVUS-defined lesions toward the proximal LMCA ( P =0.001). At the maximal %NC site, the proximal LAD segment carried the largest necrotic core [32.7% (25.7–40.1), P <0.001] and the most frequent virtual histology thin-cap fibroatheroma (67.6%, P <0.001) among the segments, followed by the proximal LMCA [30.3% (22.3–40.0) and 32.9%, respectively]. Most of the plaques carried, at least, one slice of fibroatheroma in every segment; thus, fibroatheroma distributed in a continuous pattern from the proximal LAD to the proximal LMCA. Conclusion: In the significant LMCA bifurcation disease, the proximal LAD segment was found to have the smallest lumen, the largest plaque burden, the highest virtual histology thin-cap fibroatheroma rate, and thus presented the most vulnerable characteristics by virtual histology intravascular ultrasound.