title: Comparison of coronary artery lesion length by NIRS-IVUS versus angiography alone.
abstract: BACKGROUND
  Intravascular ultrasound (IVUS) studies analyzing target lesion plaque burden (PB) have established that invasive coronary angiography commonly underestimates lesion length, predisposing to 'geographic miss' during a percutaneous coronary intervention, which has been associated with adverse outcomes. Plaque composition may also influence stent outcome. The present study used near-infrared spectroscopy and IVUS (NIRS-IVUS) to assess the prevalence of PB and lipid-core plaque (LCP) extending beyond angiographic borders of target lesions.
  
  
  METHODS
  Fifty-eight patients (58 lesions) undergoing NIRS-IVUS were identified. By invasive coronary angiography, target lesion length and minimum lumen diameter were measured. Plaque, defined as NIRS-IVUS atheroma (either PB>40% or LCP), was identified adjacent to the angiographic-defined lesion margins.
  
  
  RESULTS
  By NIRS-IVUS, atheroma (either PB>40% or LCP) was identified beyond angiographic lesion margins in 52/58 (90%) lesions. The mean lesion length was 13.4±5.9 mm by angiography and 19.8±7.0 mm (P<0.0001) by NIRS-IVUS. LCP extending beyond the angiographic border was observed in 30/58 (52%) lesions.
  
  
  CONCLUSIONS
  NIRS-IVUS imaging shows that target lesion length is commonly underestimated by angiography alone. This finding may have implications for stent length selection and avoidance of geographic miss.
authors.affiliation: aBeaumont Health System, Royal Oak, Michigan bColumbia University Medical Center and the Cardiovascular Research Foundation, New York, New York, USA.
authors.forename: Ivan D
authors.initials: ID
authors.lastname: Hanson
authors.forename: James A
authors.initials: JA
authors.lastname: Goldstein
authors.forename: Simon R
authors.initials: SR
authors.lastname: Dixon
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
mesh_terms: D015415:Biomarkers / Q000032:analysis; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000378:metabolism; D003331:Coronary Vessels / Q000737:chemistry / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008055:Lipids / Q000032:analysis; D008297:Male; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D012042:Registries; D015203:Reproducibility of Results; D012189:Retrospective Studies; D019265:Spectroscopy, Near-Infrared; D018084:Ultrasonography, Interventional
chemical_list: D015415:Biomarkers; D008055:Lipids