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Plaque composition and morphologic characteristics in significant left main bifurcation disease; virtual histology intravascular ultrasound study

Chang, Mineok; Kang, Soo-Jin; Yoon, Sung-Han; Ahn, Jung-Min; Park, Duk-Woo; Lee, Seung-Whan; Kim, Young-Hak; Lee, Cheol Whan; Park, Seong-Wook; Nakazawa, Gaku; Mintz, Gary S.; Park, Seung-Jung

doi: 10.1097/MCA.0000000000000417
Original Research

Objectives Although the left main coronary artery (LMCA) is clinically the most important site, little is known about the longitudinal plaque distribution and composition in the significant LMCA disease.

Methods Preprocedure virtual histology intravascular ultrasound data were analyzed in 120 patients with significant LMCA bifurcation lesions (angiographic diameter stenosis>50%) requiring revascularization. Plaque burden and percentage of necrotic core (%NC) at the minimal lumen area site and maximal %NC site were measured in four segments: proximal LMCA, distal LMCA, left anterior descending (LAD) ostium, and proximal LAD.

Results Angiographically, a significant LMCA and ostial LAD stenosis were observed in 89.2 and 81.7% of patients, respectively. At the minimal lumen area site, the proximal LAD segment showed the smallest lumen [3.5 mm2 (2.5–4.7), P<0.001] and the greatest plaque burden [73.2% (63.0–79.3), P<0.001] compared with the other segments. Also, there was a significant downward trend in the number of IVUS-defined lesions toward the proximal LMCA (P=0.001). At the maximal %NC site, the proximal LAD segment carried the largest necrotic core [32.7% (25.7–40.1), P<0.001] and the most frequent virtual histology thin-cap fibroatheroma (67.6%, P<0.001) among the segments, followed by the proximal LMCA [30.3% (22.3–40.0) and 32.9%, respectively]. Most of the plaques carried, at least, one slice of fibroatheroma in every segment; thus, fibroatheroma distributed in a continuous pattern from the proximal LAD to the proximal LMCA.

Conclusion In the significant LMCA bifurcation disease, the proximal LAD segment was found to have the smallest lumen, the largest plaque burden, the highest virtual histology thin-cap fibroatheroma rate, and thus presented the most vulnerable characteristics by virtual histology intravascular ultrasound.

aDepartment of Cardiology, Seoul St Mary’s Hospital, The Catholic University of Korea

bDepartment of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

cDepartment of Cardiology, Tokai University School of Medicine, Isehara, Kanagawa, Japan

dCardiovascular Research Foundation, New York, New York, USA

Correspondence to Soo-Jin Kang, MD, PhD, Department of Cardiology, Asan Medical Center, 388-1 Poongnap-dong, Songpa-gu, 138-736 Seoul, South Korea Tel: +82 230 104 812; fax: +82 247 56898; e-mail:

Received March 4, 2016

Received in revised form June 19, 2016

Accepted July 3, 2016

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.