title: Atheroma morphology and distribution in proximal left anterior descending coronary artery: in vivo observations.
abstract: OBJECTIVE
  This study sought to examine, in vivo, the shape and position of atheroma in the proximal left anterior descending coronary artery.
  
  
  BACKGROUND
  The prevalence, shape and location of atheromas involving the proximal left anterior descending artery have implications regarding the role of disturbed shear forces in the genesis of atherosclerosis. However, no data are available regarding in vivo findings or advanced disease.
  
  
  METHODS
  Forty-two consecutive high quality intravascular ultrasound images were examined from patients with atherosclerotic disease in the proximal left anterior descending artery just distal to the left main bifurcation. Lesion percent area stenosis and maximal, minimal and flow divider intimal-medial thickness were measured at the region immediately after the circumflex takeoff. The angle formed by the midpoint of the flow divider, the human center of gravity and the maximal plaque thickness were determined.
  
  
  RESULTS
  Eccentricity of vessel wall atheroma was observed such that the maximal wall thickness (1.42 +/- 0.50 mm [mean +/- SD]) differed significantly from minimal wall thickness (0.17 +/- 0.098 mm). Further, the region of vessel wall manifesting maximal thickness was greater than the flow divider thickness (0.26 +/- 0.16 mm). Maximal plaque thickness spared the region of the flow divider in 100% of cases and was positioned at a mean angle of 193 +/- 49 degrees from the center of the flow divider. Eccentric morphology was maintained across the 24% to 80% range of area stenosis.
  
  
  CONCLUSIONS
  Atheromas in the very proximal left anterior descending artery are located opposite the circumflex takeoff, spare the flow divider and maintain eccentricity across a wide range of vessel stenoses. These in vivo morphologic data support the potential role of fluid dynamic mechanical factors in atherogenesis and have implications regarding the success of catheter-based interventional procedures at the site.
authors.affiliation: Division of Cardiovascular Medicine, University of California-San Diego Medical Center, California 92103, USA.
authors.forename: B J
authors.initials: BJ
authors.lastname: Kimura
authors.forename: R J
authors.initials: RJ
authors.lastname: Russo
authors.forename: V
authors.initials: V
authors.lastname: Bhargava
authors.forename: M B
authors.initials: MB
authors.lastname: McDaniel
authors.forename: K L
authors.initials: KL
authors.lastname: Peterson
authors.forename: A N
authors.initials: AN
authors.lastname: DeMaria
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001158:Arteries; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000473:pathology*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D012044:Regression Analysis; D018084:Ultrasonography, Interventional