Plaque composition and morphologic characteristics in significant left main bifurcation disease; Virtual histology intravascular ultrasound study

TY - JOUR

T1 - Plaque composition and morphologic characteristics in significant left main bifurcation disease; Virtual histology intravascular ultrasound study

AU - Chang, Mineok

AU - Kang, Soo Jin

AU - Yoon, Sung Han

AU - Ahn, Jung Min

AU - Park, Duk Woo

AU - Lee, Seung Whan

AU - Kim, Young Hak

AU - Lee, Cheol Whan

AU - Park, Seong Wook

AU - Nakazawa, Gaku

AU - Mintz, Gary S.

AU - Park, Seung Jung

N1 - Publisher Copyright: © Copyright 2016 Wolters Kluwer Health, Inc. All rights reserved.

PY - 2016

Y1 - 2016

N2 - 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 [3.5mm2 (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.

AB - 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 [3.5mm2 (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.

KW - left main coronary artery disease

KW - virtual histology intravascular ultrasound

KW - vulnerable plaque

UR - https://www.scopus.com/pages/publications/84981710192

U2 - 10.1097/MCA.0000000000000417

DO - 10.1097/MCA.0000000000000417

M3 - Article

C2 - 27518220

SN - 0954-6928

VL - 27

SP - 623

EP - 628

JO - Coronary Artery Disease

JF - Coronary Artery Disease

IS - 8

ER -