Intravascular ultrasound classification of plaque distribution in left main coronary artery bifurcations: where is the plaque really located?
BACKGROUND
Angiographic classifications of the location and severity of disease in the main vessel and side branch of coronary artery bifurcations have been proposed and applied to distal left main coronary artery (LMCA) bifurcation.


RESULTS
We reviewed 140 angiograms of distal LMCA and ostial left anterior descending (LAD) and left circumflex (LCX) artery lesions with preintervention intravascular ultrasound (IVUS) of both the LAD and LCX arteries as well as the LMCA. Of 140 patients, 92.9% had at least 1 cross section with > or =40% IVUS plaque burden versus 57.2% of patients with an angiographic diameter stenosis > or =50%. Contrary to angiographic classifications, IVUS showed that bifurcation disease was rarely focal and that both sides of the flow divider were always disease-free. Continuous plaque from the LMCA into the proximal LAD artery was seen in 90%, from the LMCA into the LCX artery in 66.4%, and from the LMCA into both the LAD and LCX arteries in 62%. Plaque localized to either the LAD or LCX ostium and not involving the distal LMCA was seen in only 9.3% of LAD arteries and 17.1% of LCX arteries. Plaque distribution was not influenced by the LAD/LCX angiographic angle, lesion severity, LMCA length, or remodeling. We proposed an IVUS classification for bifurcation lesions illustrating longitudinal and circumferential spatial plaque distribution.


CONCLUSIONS
Angiographic classification of LMCA bifurcation lesions is rarely accurate. IVUS shows that the carina is always spared and that the disease is diffuse rather than focal.
Oviedo
Carlos
C
Cardiovascular Research Foundation and Columbia University Medical Center, 111 East 59th Street, New York, NY 10022, USA.
Maehara
Akiko
A
Mintz
Gary S
GS
Araki
Hiroshi
H
Choi
So-Yeon
SY
Tsujita
Kenichi
K
Kubo
Takashi
T
Doi
Hiroshi
H
Templin
Barry
B
Lansky
Alexandra J
AJ
Dangas
George
G
Leon
Martin B
MB
Mehran
Roxana
R
Tahk
Seung Jea
SJ
Stone
Gregg W
GW
Ochiai
Masahiko
M
Moses
Jeffrey W
JW
D000368:Aged; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000145:classification / Q000000981:diagnostic imaging* / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D018084:Ultrasonography, Interventional