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Intravascular Ultrasound Classification of Plaque in Angiographic True Bifurcation Lesions of the Left Main Coronary
Li Li1, Debabrata Dash2, Lu-Yue Gai3
1Department of Cardiology, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, Guangdong 510020, China.
Insights
Intravascular ultrasound (IVUS) classified left main coronary artery (LMCA) bifurcation plaques into four types, revealing distinct compositions. Plaques at the left anterior descending (LAD) ostium were often soft, while those in the left circumflex (LCX) and distal LMCA were typically fibrous.
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
- Biomedical Engineering
Background:
- Accurate characterization of left main coronary artery (LMCA) bifurcation plaques is crucial for optimal intervention strategies.
- Coronary angiography has limitations in precisely assessing plaque location and nature in bifurcation lesions.
- Existing intravascular ultrasound (IVUS) classification schemes for unprotected LMCA true bifurcation lesions are limited, and plaque composition remains underexplored.
Purpose of the Study:
- To detect and characterize plaque composition at LMCA bifurcation lesions using IVUS.
- To develop a classification scheme for true bifurcation lesions of the unprotected LMCA based on plaque characteristics.
Main Methods:
- Fifty-eight patients with LMCA bifurcation lesions were recruited.
- Intravascular ultrasound (IVUS) was used to assess plaque location, concentricity/eccentricity, maximum thickness site, and composition in the distal LMCA, ostial left anterior descending (LAD) coronary artery, and left circumflex (LCX) coronary artery.
- Illustrative diagrams were used to describe plaque characteristics.
Main Results:
- A four-type classification (A, B, C, D) for LMCA true bifurcation lesions was established based on plaque distribution and morphology.
- The carina was involved in only 3.5% of analyzed plaques.
- Plaque composition varied: 51.7% of ostial LAD plaques were soft, while 44.8% of distal LMCA plaques and 44.6% of ostial LCX plaques were fibrous.
Conclusions:
- A novel four-type classification system for LMCA true bifurcation lesions was developed using IVUS.
- The study confirmed that the carina is consistently free from disease in these lesions.
- Plaque characteristics differ by location: ostial LAD plaques tend to be soft, whereas distal LMCA and ostial LCX plaques are predominantly fibrous.
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.
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