Related Experiment Video
Updated: Jun 14, 2026
Point-of-Care Ultrasound for Peripheral Veno-Arterial Extracorporeal Membrane Oxygenation Without Left Ventricular Venting
Published on: January 17, 2025
Is accurate intravascular ultrasound evaluation of the left circumflex ostium from a left anterior descending to left
Carlos Oviedo1, Akiko Maehara, Gary S Mintz
1Cardiovascular Research Foundation and Columbia University Medical Center, New York, New York, USA.
Insights
Intravascular ultrasound assessment of side branch ostia in left main coronary artery bifurcations is only moderately reliable from the main vessel. Direct imaging is necessary for accurate evaluation of ostial disease severity.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Imaging
Background:
- Left main coronary artery bifurcation lesions require accurate assessment of ostial disease severity in both the main vessel and side branches.
- Intravascular ultrasound (IVUS) is a key imaging modality for evaluating coronary artery disease.
- The reliability of assessing side branch ostia from the main vessel using IVUS requires further investigation.
Purpose of the Study:
- To evaluate the accuracy of intravascular ultrasound (IVUS) assessment of side branch ostia (left circumflex or left anterior descending) from the main vessel compared to direct imaging.
- To determine if IVUS imaging from the main vessel provides reliable measurements of plaque burden and lumen diameter at the ostium of the contralateral side branch.
Main Methods:
- Retrospective analysis of 126 patients with left main coronary artery bifurcation disease (plaque burden ≥40% by IVUS).
- IVUS pullbacks were performed from the left anterior descending (LAD) to assess the ostial left circumflex (LC) and vice versa.
- Oblique views from the main vessel were compared with direct ostial measurements using Bland-Altman analysis.
Main Results:
- Oblique LC ostial lumen diameter (3.0 ± 0.8 mm) was similar to direct measurements (2.9 ± 0.6 mm), and oblique LAD ostial lumen diameter (2.9 ± 1.1 mm) was similar to direct measurements (2.8 ± 0.5 mm).
- However, Bland-Altman plots revealed significant variations, with 95% limits of agreement ranging from -1.84 to 1.14 mm for LAD and -1.69 to 1.22 mm for LC.
- Oblique view plaque detection showed good sensitivity but poor specificity for predicting significant plaque burden (≥40% or ≥70%).
Conclusions:
- Intravascular ultrasound evaluation of a side branch ostium from the main vessel is only moderately reliable, particularly for distal left main coronary artery lesions.
- Significant variations exist between oblique and direct IVUS measurements of ostial dimensions.
- Direct imaging of the side branch ostium is necessary for an accurate assessment of disease severity in left main coronary artery bifurcation lesions.
Abstract:
Treatment of left main coronary artery bifurcation lesions might depend on the ostial left circumflex (LC) or ostial left anterior descending (LAD) disease severity. We sought to evaluate whether intravascular ultrasound assessment of the side branch ostium requires direct imaging or is accurate from the main vessel. Our retrospective analysis included 126 patients with left main coronary artery bifurcation disease (plaque burden > or =40% by intravascular ultrasound scanning). We analyzed pullbacks from the LAD and the LC. First, during the main vessel pullback (ie, from the LAD), we evaluated the side branch ostium (ie, of the LC). Second, we compared this oblique view with the direct ostial measurements during LC pullback. Finally, we repeated this process, imaging the ostial LAD from the LC. From the LAD, the oblique LC ostial lumen diameter was 3.0 +/- 0.8 mm compared to the directly measured lumen diameter of 2.9 +/- 0.6 mm. From the LC, the oblique LAD ostial lumen diameter was 2.9 +/- 1.1 mm compared to the directly measured lumen diameter of 2.8 +/- 0.5 mm. However, Bland-Altman plots showed significant variation in the oblique versus direct comparisons. The 95% limits of agreement ranged from -1.84 to 1.14 mm (mean difference -0.35, SD 0.75) for the LAD and -1.69 to 1.22 mm (mean difference -0.23, SD 0.73) for the LC. The "oblique view" detection of any plaque in the side branch predicted 40% or 70% plaque burden with good sensitivity but poor specificity. In conclusion, intravascular ultrasound evaluation of a side branch ostium from the main vessel is only moderately reliable, especially for distal left main coronary artery lesions. For an accurate assessment of the side branch ostium, direct imaging is necessary.
