Intravascular ultrasound and 3D angle measurements of coronary bifurcations.
OBJECTIVE
To standardize the intravascular ultrasound (IVUS) analysis of coronary bifurcations.


BACKGROUND
Percutaneous treatment of bifurcation lesions is difficult particularly at the side branch ostium. Imaging techniques may improve our understanding of treatment options. There is no established IVUS methodology to assess the bifurcation. The present study aims to develop standards for bifurcation imaging.


METHODS
Quantitative IVUS analysis and 3D bifurcation angle measurements were performed in 34 patients who were selected from the Washington Hospital Center Database. Patients were included if both left anterior descending (LAD) and first diagonal (DX) pullbacks in the same procedure were done. Angiograms were available in 27 patients to measure the 3D bifurcation angle using specialized software. Pullbacks were analyzed proximal and distal to the bifurcation, and at the bifurcation.


RESULTS
Prox(LAD) versus Prox(LAD(DX)) were similar for vessel area (15.5 +/- 4.6 mm(2) vs. 15.9 +/- 4.0 mm(2), P = 0.19), lumen area (8.3 +/- 3.6 mm(2) vs. 8.6 +/- 3.3 mm(2), P = 0.25), and plaque area (7.2 +/- 2.0 mm(2) vs. 7.3 +/- 1.9 mm(2), P = 0.55). However, Bifurcation(LAD) was larger than Bifurcation(DX) for vessel area (17.3 +/- 4.0 mm(2) vs. 16.6 +/- 3.9 mm(2), P = 0.0083). The 3D angiographic bifurcation angle was 50 degrees +/- 13 degrees (range of 26 degrees -84 degrees), and did not affect the IVUS measurements. IVUS analysis showed that bifurcation lesions did obey Murray's Law, as Prox(LAD) lumen area measured 36.7 +/- 25.1 mm(3) versus Dist(LAD)/Dist(DX) measured 38.0 +/- 29.1 mm(3), P = 0.56.


CONCLUSIONS
Two IVUS pullbacks should be performed for a complete assessment of the bifurcation and comparison with Murray's Law. The proposed IVUS analysis was not influenced by the bifurcation angle.
van der Waal
Eva C
EC
Department of Cardiology, Thoraxcenter, Erasmus MC Rotterdam, The Netherlands.
Mintz
Gary S
GS
Garcia-Garcia
Hector M
HM
Bui
Anh B
AB
Pehlivanova
Marieta
M
Girasis
Chrysafios
C
Serruys
Patrick W
PW
van der Giessen
Wim J
WJ
Weissman
Neil J
NJ
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000628:therapy; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D019992:Databases as Topic; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000592:standards; D021621:Imaging, Three-Dimensional / Q000592:standards; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D011857:Radiographic Image Interpretation, Computer-Assisted; D018084:Ultrasonography, Interventional / Q000592:standards