Comparative intravascular ultrasound analysis of ostial disease in the left main versus the right coronary artery.
BACKGROUND
Significant aorto-ostial disease is difficult to evaluate with angiography and sometimes even with intravascular ultrasound (IVUS).


METHODS
We used IVUS to compare ostial lesions in the left main coronary (LMCA, n = 45) versus the right coronary artery (RCA, n = 50). IVUS measurements were performed each 1 mm beginning within the ostium and continuing to the distal reference segment. Negative remodeling was defined as a remodeling index (lesion/distal reference arterial area) < 0.95.


RESULTS
Patient age was 66 +/- 11 years in the LMCA group and 66 +/- 11 years in the RCA group; 56% of the LMCA ostial lesions and 46% of RCA ostial lesions were in males, and 35% of the LMCA ostial lesions and 20% of the RCA ostial lesions were in diabetics. With the exception of a smaller minimum lumen area (p < 0.0001) and distal reference plaque burden (p = 0.002) in ostial RCA lesions and a larger eccentricity index in ostial LMCA lesions (p = 0.001), both sites were remarkably similar. Both ostial LMCA and RCA lesions were short, had modest amounts of calcium, had modest plaque burdens, but had a marked frequency of negative remodeling (84% in LMCA and 86% in RCA; p = 1.0).


CONCLUSIONS
IVUS morphometry is similar in ostial LMCA and RCA lesions; negative remodeling is the dominant contributor to lumen compromise in both locations.
Kim
Sang-Wook
SW
Cardiovascular Research Institute/Medstar Research Institute, Washington Hospital Center, Washington, DC 20010, USA.
Mintz
Gary S
GS
Ohlmann
Patrick
P
Hassani
Salah-Eddine
SE
Michalek
Aleksandra
A
Escolar
Esteban
E
Bui
Anh B
AB
Pichard
Augusto D
AD
Satler
Lowell F
LF
Kent
Kenneth M
KM
Suddath
William O
WO
Waksman
Ron
R
Weissman
Neil J
NJ
D000368:Aged; D001011:Aorta / Q000000981:diagnostic imaging; D002114:Calcinosis / Q000000981:diagnostic imaging*; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018084:Ultrasonography, Interventional