Unrecognized left main coronary artery disease in patients undergoing interventional procedures

Hermiller, James; Buller, Christopher E.; Tenaglia, Alan N.; Kisslo, Katherine B.; Phillips, Harry R.; Bashore, Thomas M.; Stack, Richard S.; Davidson, Charles J.

doi:10.1016/0002-9149(93)90734-t

Cited by 102 publications

(41 citation statements)

References 18 publications

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“…Likewise, when angiographic assessment of an LMCS was compared with that of IVUS, there was a very high percentage of patients with an angiographically normal LMCA who were found to have coronary disease by IVUS. 20 In addition, Abizaid et al 13 reported that in patients with an LMCS, IVUS MLD was correlated poorly with QCA MLD; these investigators also reported that in contrast to IVUS, QCA MLD and the percent diameter stenosis were not predictive of event rates.…”

Section: Jasti Et Al Ffr Vs Ivus For Left Main Coronary Stenosismentioning

confidence: 99%

Correlations Between Fractional Flow Reserve and Intravascular Ultrasound in Patients With an Ambiguous Left Main Coronary Artery Stenosis

et al. 2004

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Background-Intravascular ultrasound (IVUS) is being used to assess the significance of a left main coronary artery stenosis (LMCS). However, the cutoff values of IVUS parameters at which to predict a fractional flow reserve (FFR) of 0.75 are unknown. Methods and Results-In 55 patients with an angiographically ambiguous LMCS, a pressure guidewire was used to calculate FFR, and IVUS parameters were calculated after automatic pullback. FFR averaged 0.86Ϯ0.13 (range, 0.55 to 1.0). IVUS minimum lumen diameter (MLD), minimum lumen area (MLA), cross-sectional narrowing (CSN), and area stenosis (AS) were 3.8Ϯ0.61 mm, 7.65Ϯ2.9 mm 2 , 59Ϯ13%, and 47Ϯ19%, respectively. Regression analysis demonstrated strong correlations between FFR and MLD (rϭ0.79, PϽ0.0001) as well as between FFR and MLA (rϭ0.74, PϽ0.0001). There were inverse, moderate correlations between FFR and CSN (rϭ0.69, PϽ0.0001), followed by those between FFR and AS (rϭ0.54, PϽ0.0001). Compared with FFR as the "gold standard," an MLD of 2.8 mm had the highest sensitivity and specificity (93% and 98%, respectively) for determining the significance of an LMCS, followed by an MLA of 5.9 mm 2 (93% and 95%, respectively). Based on an FFR Ͻ0.75 and an FFR Ն0.75, the 38-month survival and event-free survival estimates (EFSEs) were both 100% and 100% versus 90%, respectively (PϭNS). Conclusions-We conclude that (1) an IVUS MLD and MLA of 2.8 mm and 5.9 mm 2 , respectively, strongly predict the physiological significance of an LMCS and (2) among patients with an LMCS, an FFR of 0.75 is a strong predictor of survival and EFSE.

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Section: Jasti Et Al Ffr Vs Ivus For Left Main Coronary Stenosismentioning

confidence: 99%

Correlations Between Fractional Flow Reserve and Intravascular Ultrasound in Patients With an Ambiguous Left Main Coronary Artery Stenosis

et al. 2004

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“…When angiographic assessment of the LMCA bifurcation is compared with that by intravascular ultrasound (IVUS), there is a high percentage of patients with an angiographically normal LMCA bifurcation who have disease by IVUS. 3 Furthermore, there continues to be significant inter-and intraobserver variability in assessment of LMCA lesion severity. [7][8][9][10][11][12][13] Currently, there are multiple coronary angiographic bifurcation lesion classification schemes in the literature.…”

Section: Editorial See P 94 Clinical Perspective On P 112mentioning

confidence: 99%

“…1 The left main coronary artery (LMCA) is 1 of the most important sites of atherosclerotic plaque accumulation. [2][3][4][5] Blood flow is slow, and it changes direction with the cardiac cycle, resulting in a weak net hemodynamic shear stress. 6 …”

mentioning

confidence: 99%

Intravascular Ultrasound Classification of Plaque Distribution in Left Main Coronary Artery Bifurcations

Oviedo

Maehara

Mintz

et al. 2010

Circ: Cardiovascular Interventions

205

123

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Background-Angiographic classifications of the location and severity of disease in the main vessel and side branch of coronary artery bifurcations have been proposed and applied to distal left main coronary artery (LMCA) bifurcation. Methods and Results-We reviewed 140 angiograms of distal LMCA and ostial left anterior descending (LAD) and left circumflex (LCX) artery lesions with preintervention intravascular ultrasound (IVUS) of both the LAD and LCX arteries as well as the LMCA. Of 140 patients, 92.9% had at least 1 cross section with Ն40% IVUS plaque burden versus 57.2% of patients with an angiographic diameter stenosis Ն50%. Contrary to angiographic classifications, IVUS showed that bifurcation disease was rarely focal and that both sides of the flow divider were always disease-free. Continuous plaque from the LMCA into the proximal LAD artery was seen in 90%, from the LMCA into the LCX artery in 66.4%, and from the LMCA into both the LAD and LCX arteries in 62%. Plaque localized to either the LAD or LCX ostium and not involving the distal LMCA was seen in only 9.3% of LAD arteries and 17.1% of LCX arteries. Plaque distribution was not influenced by the LAD/LCX angiographic angle, lesion severity, LMCA length, or remodeling. We proposed an IVUS classification for bifurcation lesions illustrating longitudinal and circumferential spatial plaque distribution. Conclusions-Angiographic

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“…83 Similarly, intravascular sonography revealed some degree of stenosis in 80% of angiographically normal left main coronary arteries after percutaneous transluminal coronary angioplasty. 85 A more accurate assessment of carotid artery stent dimensions, expansion, and apposition can be obtained through intravascular sonography, compared with quantitative carotid angiography. Clark et al 13 found that the measurements provided by intravascular sonography of the internal carotid artery stent minimal lumen diameter were significantly smaller than those provided by quantitative carotid angiography (3.65 Ϯ 0.68 versus 4.31 Ϯ 0.76 mm; P Ͻ .001).…”

Section: Comparison Of Intravascular Sonography and Angiographymentioning

confidence: 99%

Intravascular Ultrasound: Principles and Cerebrovascular Applications

Zacharatos¹,

Hassan²,

Qureshi³

2010

AJNR Am J Neuroradiol

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SUMMARY: Intravascular sonography is a valuable tool for the morphologic assessment of coronary atherosclerosis and the effect of pharmacologic and nonpharmacologic interventions on the progression or stabilization of atherosclerosis. An analysis of the different modes, applications, and limitations is provided on the basis of review of existing data from multiple clinical case studies, trials, and mechanistic studies. Intravascular sonography has been used to assess the outcomes of different percutaneous interventions, including angioplasty and stent implantation, and to provide detailed characterization of atherosclerotic lesions, aneurysms, and dissections within the cerebrovascular circulation. Evolution of intravascular sonographic technology has led to the development of more sophisticated diagnostic tools such as color-flow, virtual histology, and integrated backscatter intravascular sonography. The technologic advancement in intravascular sonography has the potential of providing more accurate information prior, during, and after a medical or endovascular intervention. Continued assessment of this diagnostic technique in both the intracranial and extracranial circulation will lead to increased use in clinical practice with the intent to improve outcomes.ABBREVIATIONS: CI ϭ confidence interval; EEL ϭ external elastic lamina; O.D. ϭ outer diameter C urrently there are 3 types of sonography used to assess the extracranial and the intracranial circulation: 1) transcranial Doppler, 2) B-mode sonography, and 3) intravascular sonography (Table). The morphologic appearance of the intra-arterial and intravenous circulation can now be visualized by using intravascular sonography, which has become a commonly used diagnostic technique for randomized clinical trials assessing coronary plaque progression and regression. With excellent resolution, intravascular sonography provides cross-sectional images of both the arterial wall and lumen and identifies intimal flaps and irregularities, and the composition and extent of the atherosclerotic plaque.2-6 Evolution of the intravascular sonography technology has led to the development of more sophisticated diagnostic tools such as colorflow, virtual histology, and integrated backscatter intravascular sonography. 7 The successful application of conventional (gray-scale) intravascular sonography in the coronary arteries has led to its application within the extracranial and intracranial arteries. Recently, intravascular sonography has also been used to identify and characterize carotid artery aneurysm, dissection, and thrombus. 8 Intravascular sonography has been used successfully to assist in making measurements before and after percutaneous transluminal balloon angioplasty and stent placement, with emphasis on the identification of stent underexpansion, poor apposition, subacute stent thrombosis, and plaque protrusion.9,10 Real-time dynamic intravascular sonography of the cervical common carotid artery and internal carotid artery can detect defects that are not readily appar...

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Unrecognized left main coronary artery disease in patients undergoing interventional procedures

Cited by 102 publications

References 18 publications

Correlations Between Fractional Flow Reserve and Intravascular Ultrasound in Patients With an Ambiguous Left Main Coronary Artery Stenosis

Correlations Between Fractional Flow Reserve and Intravascular Ultrasound in Patients With an Ambiguous Left Main Coronary Artery Stenosis

Intravascular Ultrasound Classification of Plaque Distribution in Left Main Coronary Artery Bifurcations

Intravascular Ultrasound: Principles and Cerebrovascular Applications

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