The effects of a myocardial bridge on coronary atherosclerosis and ischaemia

Ishii, Toshiharu; Asuwa, Noriko; Masuda, Shinya; Ishikawa, Yukio

doi:10.1002/(sici)1096-9896(199805)185:1<4::aid-path50>3.0.co;2-3

Cited by 160 publications

(119 citation statements)

References 44 publications

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“…[19][20][21] It is not clear how much the underlying atherosclerotic plaques contribute to in-stent restenosis, but both the deep injury and the vessel stretch were shown to trigger the development of in-stent neointima in even normal coronary arteries. 22) Although maximum deployment pressures were not different between the two groups, an additional external force on the vessel wall might have caused a deeper injury in the MB group.…”

Section: Discussionmentioning

confidence: 99%

Angiographic Restenosis After Myocardial Bridge Stenting: A Comparative Study With Direct Stenting of De-Novo Atherosclerotic Lesions

et al. 2004

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SUMMARYData on restenosis after stent implantation in myocardial bridges (MB) are very limited. Six-month angiographic results for 12 symptomatic patients who underwent stent implantation for myocardial bridges were compared retrospectively with those of 39 patients who underwent direct stent implantation for de novo atherosclerotic lesions in the left anterior descending artery. Diameter stenosis decreased from 69 ± 8% to 4 ± 5% in the MB group and from 79 ± 8% to 7 ± 6% in the control group after stent deployment. Systolic narrowing was abolished in all patients with MB. In follow-up, quantitative angiography revealed late loss of 1.8 ± 1.3 mm in the MB group and 0.9 ± 0.9 mm in the control group (P = 0.025). The in-stent restenosis rate was also higher in the MB group compared to the control group (67% versus 28%; P = 0.037). Despite favorable immediate results, stent implantation in MBs may not be promising because of the higher in-stent restenosis rate compared to stenting in de novo atherosclerotic lesions. ( A myocardial bridge (MB) is an anatomical variation in which a part of a coronary artery (mostly left anterior descending artery (LAD)) courses under a segment of myocardium that compresses the lumen during systole despite a normal appearance during diastole. The reported incidence of MB varies over a wide range according to the method of diagnosis, changing from 0.5 to 2.5% in angiographic studies to 15 to 85% in autopsy series.1-3) Although known as a benign and asymptomatic condition in a majority of the patients, MBs may cause angina, myocardial ischemia, infarction, life-threatening cardiac arrhythmias, and even sudden cardiac death. [4][5][6][7][8] The clinical management of patients with symptomatic MB is not well established. On the basis of previous pathophysiological and clinFrom the

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Section: Discussionmentioning

confidence: 99%

Angiographic Restenosis After Myocardial Bridge Stenting: A Comparative Study With Direct Stenting of De-Novo Atherosclerotic Lesions

et al. 2004

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“…These adverse effects likely result from 2 distinct mechanisms: (1) accelerated plaque formation in the segment proximal to the MB, as investigated in the current study, and (2) alteration in the effective blood perfusion of the affected myocardial territory owing to delayed arterial relaxation in diastole or the Venturi effect on the septal branches that can cause functional ischemia of the septal wall 4. Furthermore, external systolic compression and endothelial dysfunction frequently observed in the tunneled artery could stimulate coronary vasospasm and platelet aggregation resulting in acute coronary syndrome in certain clinical settings 16, 21, 23, 24…”

Section: Discussionmentioning

confidence: 89%

Functional Versus Anatomic Assessment of Myocardial Bridging by Intravascular Ultrasound: Impact of Arterial Compression on Proximal Atherosclerotic Plaque

Yamada

Tremmel

Tanaka

et al. 2016

JAHA

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BackgroundThe presence of a myocardial bridge (MB) has been shown to promote atherosclerotic plaque formation proximal to the MB, presumably because of hemodynamic disturbances provoked by retrograde blood flow toward this segment in cardiac systole. We aimed to determine the anatomic and functional properties of an MB related to the extent of atherosclerosis assessed by intravascular ultrasound.Methods and ResultsWe enrolled 100 patients with angina but no significant obstructive coronary artery disease who had an intravascular ultrasound–detected MB in the left anterior descending artery (median age 54 years, 36% male). The MB was identified with intravascular ultrasound by the presence of an echolucent band (halo). Anatomically, the MB length was 22±13 mm, and halo thickness was 0.7±0.6 mm. Functionally, systolic arterial compression was 23±12%. The maximum plaque burden up to 20 mm proximal to the MB entrance was significantly greater than the maximum plaque burden within the MB segment. Among the intravascular ultrasound–defined MB properties, arterial compression was the sole MB parameter that demonstrated a significant positive correlation with maximum plaque burden up to 20 mm proximal to the MB entrance (r=0.254, P=0.011 overall; r=0.545, P<0.001 low coronary risk). In multivariate analysis, adjusting for clinical characteristics and coronary risk factors, arterial compression was independently associated with maximum plaque burden up to 20 mm proximal to the MB entrance.ConclusionsIn patients with an MB in the left anterior descending artery, the percentage of arterial compression is related directly to the burden of atherosclerotic plaque located proximally to the MB, particularly in patients who otherwise have low coronary risk. This may prove helpful in identifying high‐risk MB patients.

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“…MB is a common anatomic anomaly identified by coronary CTA in routine practice and is seen in as many as 40-80% of cases on autopsy [2,3]. Although MB is generally considered a benign anomaly, it may be associated with clinical manifestations that have been linked to dynamic compression [5][6][7][8][9][10][11].…”

Section: Discussionmentioning

confidence: 99%

Attenuation Drop of Intra-Mural Coronary Segment Observed at Diastolic Phase of Coronary CT Angiography Predicts Significant Systolic Compression of Myocardial Bridge

et al. 2018

Cardiovasc Imaging Asia

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The effects of a myocardial bridge on coronary atherosclerosis and ischaemia

Cited by 160 publications

References 44 publications

Angiographic Restenosis After Myocardial Bridge Stenting: A Comparative Study With Direct Stenting of De-Novo Atherosclerotic Lesions

Angiographic Restenosis After Myocardial Bridge Stenting: A Comparative Study With Direct Stenting of De-Novo Atherosclerotic Lesions

Functional Versus Anatomic Assessment of Myocardial Bridging by Intravascular Ultrasound: Impact of Arterial Compression on Proximal Atherosclerotic Plaque

Attenuation Drop of Intra-Mural Coronary Segment Observed at Diastolic Phase of Coronary CT Angiography Predicts Significant Systolic Compression of Myocardial Bridge

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