title: Insights into the spatial distribution of lipid-rich plaques in relation to coronary artery bifurcations: an in-vivo optical coherence tomography study.
abstract: OBJECTIVE
  The aim of this study was to investigate the spatial location of vulnerable plaques at coronary artery bifurcations using frequency domain-optical coherence tomography.
  
  
  BACKGROUND
  In-vivo data on geometric location of vulnerable plaques in relation to coronary bifurcation are limited.
  
  
  METHODS
  A total of 40 patients with left anterior descending artery bifurcation were studied. Plaque characteristics in five regions in relation to a side branch were compared: opposite flow divider (OFD); bifurcation site (BF); main branch side proximal (MBP); side branch side proximal (SBP); and flow divider (FD). Frequency domain-optical coherence tomography was used for plaque characterization.
  
  
  RESULTS
  Seventy-two lipid-rich plaques and 15 thin-cap fibroatheroma (TCFA) were detected in 220 regions of 44 bifurcations. Overall, the main branch side had more vulnerable characteristics compared with the side branch side. The FD was rarely affected by lipid accumulation. The OFD showed the highest prevalence of lipid-rich plaques [47.7% (OFD) vs. 45.5% (MBP), 43.2% (BF), 18.2% (SBP), and 9.1% (FD), P<0.0001] and TCFA [20.5% (OFD) vs. 6.8% (MBP), 6.8% (BF), 2.2% (SBP), and 0.0% (FD), P<0.001] and the thinnest fibrous cap [88.7±43.7 μm (OFD) vs. 123.5±62.7 μm (MBP), 149.6±77.0 μm (BF), 157.4±65.4 μm (SBP), and 163.6±76.9 μm (FD), P=0.002] compared with other regions.
  
  
  CONCLUSIONS
  Lipid accumulation tends to develop in the zone opposite the side branch. TCFA was localized predominantly in the region OFD, whereas FD was rarely affected.
authors.affiliation: aDepartment of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin bDepartment of Medicine, Queen Mary Hospital, Hong Kong University, Hong Kong, China cCardiology Division dDepartment of Biostatistics, Massachusetts General Hospital eCardiovascular Division, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA fThe First Department of Medicine, Nara Medical University, Nara, Japan gDivision of Cardiology, Asan Medical Center hDivision of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea iCardiovascular & Cell Sciences, St George's, University of London, London, UK.
authors.forename: Haibo
authors.initials: H
authors.lastname: Jia
authors.forename: Sining
authors.initials: S
authors.lastname: Hu
authors.forename: Shiro
authors.initials: S
authors.lastname: Uemura
authors.forename: Seung-Jung
authors.initials: SJ
authors.lastname: Park
authors.forename: Yangsoo
authors.initials: Y
authors.lastname: Jang
authors.forename: Abhiram
authors.initials: A
authors.lastname: Prasad
authors.forename: Stephen
authors.initials: S
authors.lastname: Lee
authors.forename: Tsunenari
authors.initials: T
authors.lastname: Soeda
authors.forename: Farhad
authors.initials: F
authors.lastname: Abtahian
authors.forename: Rocco
authors.initials: R
authors.lastname: Vergallo
authors.forename: Jinwei
authors.initials: J
authors.lastname: Tian
authors.forename: Hang
authors.initials: H
authors.lastname: Lee
authors.forename: Peter H
authors.initials: PH
authors.lastname: Stone
authors.forename: Bo
authors.initials: B
authors.lastname: Yu
authors.forename: Ik-Kyung
authors.initials: IK
authors.lastname: Jang
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis*; D003331:Coronary Vessels / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D058226:Plaque, Atherosclerotic / Q000175:diagnosis*; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence / Q000379:methods*