title: Intravascular Ultrasound Classification of Plaque in Angiographic True Bifurcation Lesions of the Left Main Coronary Artery.
abstract: BACKGROUND
  Accurately, characterizing plaques is critical for selecting the optimal intervention strategy for the left main coronary artery (LMCA) bifurcation. Coronary angiography cannot precisely assess the location or nature of plaques in bifurcation lesions. Few intravascular ultrasound (IVUS) classification scheme has been reported for angiographic imaging of true bifurcation lesions of the unprotected LMCA thus far. In addition, the plaque composition at the bifurcation has not been elucidated. This study aimed to detect plaque composition at LMCA bifurcation lesions by IVUS.
  
  
  METHODS
  Fifty-eight patients were recruited. The location, concentricity or eccentricity, site of maximum thickness, and composition of plaques of the distal LMCA, ostial left anterior descending (LAD) coronary artery and, left circumflex (LCX) coronary artery were assessed using IVUS and described using illustrative diagrams.
  
  
  RESULTS
  True bifurcation lesions of the unprotected LMCA were classified into four types: Type A, with continuous involvement from the distal LMCA to the ostial LAD and the ostial LCX with eccentric plaques; Type B, with concentric plaques at the distal LMCA, eccentric plaques at the ostial LAD, and no plaques at the LCX; Type C, with continuous involvement from the distal LMCA to the ostial LCX, with eccentric plaques, and to the ostial LAD, with eccentric plaques; and Type D, with continuous involvement from the distal LMCA to the ostial LAD, with eccentric plaques, and to the ostial LCX, with concentric plaques. The carina was involved in only 3.5% of the plaques. A total of 51.7% of the plaques at the ostium of the LAD were soft, while 44.8% and 44.6% were fibrous in the distal LMCA and in the ostial LCX, respectively.
  
  
  CONCLUSIONS
  We classified LMCA true bifurcation lesions into four types. The carina was always free from disease. Plaques at the ostial LAD tended to be soft, whereas those at the ostial LCX and the distal LMCA tended to be fibrous.
authors.affiliation: Department of Cardiology, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, Guangdong 510020, China.
authors.forename: Li
authors.initials: L
authors.lastname: Li
authors.affiliation: Department of Cardiology, S. L. Raheja (A Fortis Associate) Hospital, Mumbai, Maharashtra, India.
authors.forename: Debabrata
authors.initials: D
authors.lastname: Dash
authors.affiliation: Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
authors.forename: Lu-Yue
authors.initials: LY
authors.lastname: Gai
authors.affiliation: Department of Cardiology, Gansu Provincial People's Hospital, Lanzhou, Gansu 730000, China.
authors.forename: Yun-Shan
authors.initials: YS
authors.lastname: Cao
authors.affiliation: Department of Cardiology, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, Guangdong 510020, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Zhao
authors.affiliation: Department of Cardiology, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, Guangdong 510020, China.
authors.forename: Ya-Rong
authors.initials: YR
authors.lastname: Wang
authors.affiliation: Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, China.
authors.forename: Yao-Jun
authors.initials: YJ
authors.lastname: Zhang
authors.affiliation: Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, China.
authors.forename: Jun-Xia
authors.initials: JX
authors.lastname: Zhang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000473:pathology*; D023921:Coronary Stenosis / Q000473:pathology; D003331:Coronary Vessels / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D058226:Plaque, Atherosclerotic / Q000175:diagnosis*; D018084:Ultrasonography, Interventional / Q000379:methods*