Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Catheter Cardiovasc Interv. 2013 Jun 1;81(7):1150-5. doi: 10.1002/ccd.24390. Epub 2013 Mar 2.
The aim of this study was to assess vascular remodeling at both mainbranch (MB) and sidebranch (SB) ostia in left main (LM), and non-LM coronary artery disease.
Using both pullback intravascular ultrasound, MB and SB ostia were evaluated in 169 bifurcation lesions with angiographic stenosis >50% before procedure. Remodeling index (RI) was the ratio of external elastic membrane (EEM) area at the minimal lumen area (MLA) site within the ostium to EEM area of distal reference.
In 81 LM bifurcation lesions, constrictive remodeling (RI < 1) was frequent at MB and SB ostia (91% and 90%). In 88 non-LM bifurcation lesions, constrictive remodeling was also frequent at the MB and SB ostia (76% and 92%). RI was the lowest at the SB ostium in non-LM bifurcation (0.80 ± 0.13). RI was related to neither large plaque burden nor extensive calcification. The non-LM bifurcation lesions with RI <1 at the SB ostium showed smaller distal carina angle (51 ± 25° vs. 64 ± 14°, P = 0.044) compared with those with RI >1. At all ostial sites of bifurcation lesions, plaque burden and RI at the ostium and EEM area of distal reference were the independent factors affecting the MLA within the corresponding ostium as a continuous variable.
At both MB and SB ostia, constrictive remodeling was frequent even in the lesions with small amount of plaque and minimal calcification, which contribute further luminal narrowing. © 2012 Wiley Periodicals, Inc.
本研究旨在评估左主干（LM）和非 LM 冠状动脉疾病中主支（MB）和分支（SB）开口处的血管重构。
使用血管内超声回拉技术，在术前对 169 个狭窄程度大于 50%的分叉病变进行 MB 和 SB 开口评估。重塑指数（RI）为 MB 和 SB 开口最小管腔面积（MLA）处的外膜弹性膜（EEM）面积与远端参考 EEM 面积的比值。
在 81 个 LM 分叉病变中，MB 和 SB 开口处常出现缩窄性重构（RI＜1）（91%和 90%）。在 88 个非 LM 分叉病变中，MB 和 SB 开口处也常出现缩窄性重构（76%和 92%）。非 LM 分叉病变的 SB 开口处 RI 最低（0.80±0.13）。RI 与大斑块负荷或广泛钙化无关。非 LM 分叉病变中 SB 开口处 RI＜1 的病变，其远端嵴角（51±25°vs.64±14°，P=0.044）小于 RI＞1 的病变。在所有分叉病变的开口部位，斑块负荷和开口处的 RI 以及远端参考 EEM 面积是影响相应开口处 MLA 的独立因素（均为连续变量）。
即使在斑块负荷小、钙化程度低的病变中，MB 和 SB 开口处也常出现缩窄性重构，这进一步导致管腔狭窄。© 2012 Wiley Periodicals, Inc.
