title: Analysis of target lesion length before coronary artery stenting using angiography and near-infrared spectroscopy versus angiography alone.
abstract: Lipid core plaque (LCP) can extend beyond the angiographic margins of a target lesion, potentially resulting in incomplete lesion coverage. We sought to compare the target lesion length using near-infrared spectroscopy (NIRS) combined with conventional coronary angiography versus angiography alone. NIRS was performed in 69 patients (75 lesions) undergoing native vessel percutaneous coronary intervention (LipiScan Coronary Imaging System). Chemograms were analyzed for the presence and location of LCP, either within or extending beyond, the angiographic margins of the target lesion. The target lesion length was measured by quantitative coronary angiography (QCA) and compared to the lesion length measured using QCA and NIRS. LCP was present in 50 target lesions (67%). In 42 lesions (84%), LCP was present only within the target lesion. In 8 lesions (16%) LCP extended beyond the angiographic margins of the lesion. Of these 8 lesions, 4 (8%) had LCP ≤5 mm from the margins, and 4 lesions (8%) had LCP >5 mm from the angiographic margins. The mean distance that the LCP extended beyond the angiographic lesion margin was 7 ± 4 mm (range 2 to 14). For these 8 lesions, the target lesion length with NIRS plus QCA was 28 ± 10 mm versus 21 ± 8 mm with QCA alone. In conclusion, patients undergoing coronary artery stenting could have LCP extending beyond the intended treatment margins as defined using QCA alone. This could have implications for stent length selection and optimal lesion coverage.
authors.affiliation: Beaumont Hospital, Royal Oak, Michigan, USA. sdixon@beaumont.edu
authors.forename: Simon R
authors.initials: SR
authors.lastname: Dixon
authors.forename: Cindy L
authors.initials: CL
authors.lastname: Grines
authors.forename: Ahmad
authors.initials: A
authors.lastname: Munir
authors.forename: Ryan D
authors.initials: RD
authors.lastname: Madder
authors.forename: Robert D
authors.initials: RD
authors.lastname: Safian
authors.forename: George S
authors.initials: GS
authors.lastname: Hanzel
authors.forename: Mark C
authors.initials: MC
authors.lastname: Pica
authors.forename: James A
authors.initials: JA
authors.lastname: Goldstein
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000175:diagnosis* / Q000601:surgery; D003331:Coronary Vessels / Q000473:pathology* / Q000601:surgery; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D057234:Preoperative Period; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D019265:Spectroscopy, Near-Infrared / Q000379:methods*; D015607:Stents