Department of Invasive Cardiology, Instituto Dante Pazzanese de Cardiologia, Av. Dante Pazzanese 500, Ibirapuera, São Paulo, SP, 04012-909, Brazil,
Int J Cardiovasc Imaging. 2013 Dec;29(8):1657-66. doi: 10.1007/s10554-013-0263-1. Epub 2013 Jul 19.
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 pre-intervention 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 1,1,1 according to the Medina classification. Considering the subset with IVUS imaging, mean lesion length, reference diameter and % diameter stenosis in the SB were 8.88 ± 4.61 mm, 2.68 ± 0.59, and 70.2 ± 16.0%, respectively. Also, mean proximal (take-off) and distal (carina) angles were 142.3 ± 21.9° and 60.7 ± 22.4°, respectively. At minimum lumena area (MLA) site, mean external elastic membrane and MLA cross-sectional areas were 6.70 ± 2.08 and 1.87 ± 0.93 mm2, respectively; given that the mean distance measured between the SB origin and MLA site was <1 mm. In addition, mean plaque burden was 67.9% and mean remodeling index was 0.78 ± 0.21. Importantly, only 9 cases out of 45 presented remodeling index > 1.0. 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.
为了研究真冠状动脉分叉病变的侧支（SB）中的血管重构和斑块分布，病变的 SB 从开口处延伸至 SB 疾病。共纳入 62 例 SB 严重广泛病变的单支新发病变的 SB 患者。其中 45 例患者/病变接受了 SB 的介入前血管内超声（IVUS）检查。左前降支是最常见的靶血管（>85%）。所有病变均累及分叉的两支分支，且大多数根据 Medina 分类为 1,1,1 型。考虑到有 IVUS 成像的亚组，SB 中的平均病变长度、参考直径和%直径狭窄分别为 8.88±4.61mm、2.68±0.59mm 和 70.2±16.0%。此外，近端（分支起始处）和远端（分叉嵴）角度分别为 142.3±21.9°和 60.7±22.4°。在最小内腔面积（MLA）部位，平均外弹力膜和 MLA 截面积分别为 6.70±2.08mm2 和 1.87±0.93mm2；由于 SB 起源处与 MLA 部位之间的平均测量距离<1mm。此外，平均斑块负荷为 67.9%，平均重构指数为 0.78±0.21。重要的是，45 例患者中仅有 9 例出现重构指数>1.0。此外，SB 开口内的斑块分布分析表明，在分又解剖学中的分流器对侧，斑块定位更好。总之，在复杂冠状动脉分叉病变的 SB 中，严重且广泛的病变经常出现明显的负性重构；此外，SB 开口内的斑块分布似乎与母血管不对称，因为斑块负荷主要发生在低壁切应力区域，包括分叉解剖学中的分流器对侧。
