Vessel remodeling and plaque distribution in side branch of complex coronary bifurcation lesions: A grayscale intravascular ultrasound study

Ricardo A. Costa, Fausto Feres, Rodolfo Staico, Alexandre Abizaid, J. Ribamar Costa, Dimytri Siqueira, Luiz F. Tanajura, Lucas P. Damiani, Amanda Sousa, J. Eduardo Sousa, Antonio Colombo

Research output: Contribution to journalArticle

Abstract

To investigate vessel remodeling and plaque distribution in side branch (SB) of true coronary bifurcation lesions with SB disease extending from its ostium. A total of 62 patients with single de novo true bifurcation lesions with SB with severe and extensive disease were enrolled. Of that, 45 patients/lesions underwent pre-intervention intravascular ultrasound (IVUS) at the SB. Left anterior descending was the most prevalent target vessel (>85 %). All lesions had significant involvement of both branches of the bifurcation, and the majority were classified as type 1,1,1 according to the Medina classification. Considering the subset with IVUS imaging, mean lesion length, reference diameter and % diameter stenosis in the SB were 8.88 ± 4.61 mm, 2.68 ± 0.59, and 70.2 ± 16.0 %, respectively. Also, mean proximal (take-off) and distal (carina) angles were 142.3 ± 21.9 and 60.7 ± 22.4, respectively. At minimum lumena area (MLA) site, mean external elastic membrane and MLA cross-sectional areas were 6.70 ± 2.08 and 1.87 ± 0.93 mm2, respectively; given that the mean distance measured between the SB origin and MLA site was 1.0. Also, plaque distribution analysis within the SB ostium demonstrated preferable plaque positioning in the opposite side to the flow divider. In conclusions, significant negative remodeling is a frequent encounter in SB of complex coronary bifurcation lesions presenting with extensive and severe disease; in addition, plaque distribution in the SB ostium appears to be asymmetric in relation to the parent vessel, as plaque burden is mostly found in regions of low wall shear stress including the opposite side to the flow divider within the bifurcation anatomy.

Original languageEnglish
Pages (from-to)1657-1666
Number of pages10
JournalInternational Journal of Cardiovascular Imaging
Volume29
Issue number8
DOIs
Publication statusPublished - Dec 2013

Keywords

  • Coronary bifurcation lesions
  • Intravascular ultrasound
  • Negative remodeling
  • Plaque distribution

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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    Costa, R. A., Feres, F., Staico, R., Abizaid, A., Costa, J. R., Siqueira, D., Tanajura, L. F., Damiani, L. P., Sousa, A., Sousa, J. E., & Colombo, A. (2013). Vessel remodeling and plaque distribution in side branch of complex coronary bifurcation lesions: A grayscale intravascular ultrasound study. International Journal of Cardiovascular Imaging, 29(8), 1657-1666. https://doi.org/10.1007/s10554-013-0263-1