Analysis of coronary bifurcations by intravascular ultrasound and virtual histology

Regional differences in shear stress have been identified as reason for early plaque formation in vessel bifurcations. We aimed to investigate regional plaque morphology and composition using intravascular ultrasound (IVUS) and virtual histology (IVUS-VH) in coronary artery bifurcations.

We performed IVUS and IVUS-VH studies at coronary bifurcations to analyze segmental plaque burden and composition of different segments in relation to their orientation to the bifurcation.

A total of 236 patients with a mean age of 59±11 years (69% male) were analyzed. Plaque burden was higher at the contralateral vessel wall facing the bifurcation compared to the ipsilateral vessel wall and this difference was true for proximal and distal segments (proximal: 37±12% and 45±15% for segments at the ipsilateral and contralateral vessel wall, respectively, p<0.001; distal: 37±10% and 47±15% for segments at the ipsilateral and contralateral vessel wall, respectively, p<0.001). In addition, these segments exhibited a higher proportion of dense calcium and a lower proportion of fibrous tissue and fibro fatty tissue.

Segments on the contralateral wall of the bifurcation which have previously been identified as regions with low shear stress not only exhibited a higher plaque burden, but also a higher degree of calcification.