Role of IVUS in the rectification of angiographically judged ramus intermedius and its clinical significance

Abstract

Background Due to the technical limitations of coronary artery angiography (CAG), ramus intermedius (RI) is sometimes difficult to distinguish from a high-origin obtuse marginal branch or a high-origin diagonal branch. This study sought to investigate the role of intravascular ultrasonography (IVUS) in the rectification of angiographically judged RI. Methods This study retrospectively analyzed 165 patients who were reported to have an RI based on CAG and underwent IVUS implementation from 02/01/2009 to 31/12/2019 in Zhongshan Hospital, Fudan University. Taking IVUS as the gold standard, we calculated the accuracy of RI identification by CAG and evaluated the impact of RI on revascularization strategy. Results Among the 165 patients, 89 patients (54%) were demonstrated to have an RI on IVUS (IVUS-RI), 32 patients (19%) were identified to have a high-origin diagonal branch on IVUS (IVUS-h-D), and 44 patients (27%) had an actual high-origin obtuse marginal artery on IVUS (IVUS-h-OM). Among 84 patients who underwent one-stent crossover stenting because of left main furcation lesions (48 patients in the IVUS-RI group, 12 patients in the IVUS-h-D group, and 24 in the IVUS-h-OM group), 14.6% of patients in the IVUS-RI group, 33.3% in the IVUS-h-D group and 0% in the IVUS-h-OM group had CAG-RI compromise (P = 0.02), which was defined as severe stenosis of the RI ostium (> 75%) or significant RI flow impairment (TIMI < 3). Conclusions Only 54% of CAG-RIs were confirmed by IVUS, which indicates the necessity of preintervention IVUS to distinguish real RIs from other branches in LM furcation lesions.

Relação entre Níveis Plasmáticos Aumentados de Legumain e Propriedades da Placa Aterosclerótica Coronária

“…According to previous IVUS studies, vascular changes in acute coronary syndrome are prone to positive remodeling compared with SA vascular lesions, and positive remodeling is closely associated with adverse events such as plaque rupture and thrombosis. 23 Additionally, we found that legumain was significantly positively correlated with RI and plaque EI in both the UA and SA groups. In summary, the risk of developing atherosclerotic cardiovascular disease rises in people without CHD as legumain levels increase.…”

“…De acordo com estudos anteriores de IVUS, as alterações vasculares na síndrome coronariana aguda são propensas a remodelamento positivo em comparação com lesões vasculares AE, e o remodelamento positivo está intimamente associado a eventos adversos, como ruptura de placa e trombose. 23 Além disso, descobrimos que a legumain foi significativamente correlacionada positivamente com o IR e o IE da placa nos grupos AI e AE. Em resumo, o risco de desenvolver doença cardiovascular aterosclerótica aumenta em pessoas sem doença coronariana à medida que os níveis de legumain aumentam.…”

The Ramus Intermedius: A Bridge to Survival in the Setting of Triple-Vessel Total Occlusion

“…One study found a significant discordance between coronary angiography (CAG) and intravascular ultrasonography (IVUS) in identifying RI. Specifically, 46% of CAG-based patients with RI were classified as having either high-origin OM or diagonal arteries upon IVUS interpretation [18]. One distinctive feature of RI is that it slides over the free surface of the LV wall rather than running through the anatomical groove, as in the case of the LAD and LCX arteries.…”