Authors: Ricardo A Costa Fausto Feres Rodolfo Staico Alexandre Abizaid J Ribamar Costa Dimytri Siqueira Luiz F Tanajura Lucas P Damiani Amanda Sousa J Eduardo Sousa Antonio Colombo
Publish Date: 2013/07/19
Volume: 29, Issue: 8, Pages: 1657-1666
Abstract
To investigate vessel remodeling and plaque distribution in side branch SB of true coronary bifurcation lesions with SB disease extending from its ostium A total of 62 patients with single de novo true bifurcation lesions with SB with severe and extensive disease were enrolled Of that 45 patients/lesions underwent preintervention intravascular ultrasound IVUS at the SB Left anterior descending was the most prevalent target vessel 85 All lesions had significant involvement of both branches of the bifurcation and the majority were classified as type 111 according to the Medina classification Considering the subset with IVUS imaging mean lesion length reference diameter and diameter stenosis in the SB were 888 ± 461 mm 268 ± 059 and 702 ± 160 respectively Also mean proximal takeoff and distal carina angles were 1423 ± 219° and 607 ± 224° respectively At minimum lumena area MLA site mean external elastic membrane and MLA crosssectional areas were 670 ± 208 and 187 ± 093 mm2 respectively given that the mean distance measured between the SB origin and MLA site was 1 mm In addition mean plaque burden was 679 and mean remodeling index was 078 ± 021 Importantly only 9 cases out of 45 presented remodeling index 10 Also plaque distribution analysis within the SB ostium demonstrated preferable plaque positioning in the opposite side to the flow divider In conclusions significant negative remodeling is a frequent encounter in SB of complex coronary bifurcation lesions presenting with extensive and severe disease in addition plaque distribution in the SB ostium appears to be asymmetric in relation to the parent vessel as plaque burden is mostly found in regions of low wall shear stress including the opposite side to the flow divider within the bifurcation anatomy
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