Intravascular Ultrasound-Guided Treatment for Angiographically Indeterminate Left Main Coronary Artery Disease: A Long-Term Follow-up Study

Abstract

We evaluated the impact of reference vessel segment plaque burden on lesion remodeling.Intravascular ultrasound (IVUS) assessment of lesion remodeling compares lesions to reference segments. However, reference segments are rarely disease-free and, therefore, have also undergone remodeling changes.Pre-intervention IVUS was obtained in 274 patients with right coronary artery lesions selected because the right coronary artery has less tapering and fewer side branches than the left anterior descending or left circumflex artery. Standard IVUS definitions were used. Patients were divided according to reference vessel segment plaque burden: group A (minimal reference disease, n = 91), both proximal and distal reference plaque burden <20%; group B (n = 91), either proximal or distal reference plaque burden 20% to 40% but both ≤40%; and group C (n = 92), either proximal or distal reference plaque burden >40%.The remodeling index measured 0.98 ± 0.16 in group A (range, 0.68 to 1.47), 1.04 ± 0.18 in group B (range, 0.67 to 1.91), and 1.04 ± 0.15 in group C (range, 0.74 to 1.70), analysis of variance p = 0.0208 (p = 0.0234 group A vs. group B and p = 0.0012 group A vs. group C, but p = 0.8 group B vs. group C). Positive, intermediate, and negative remodeling were observed in 24 (26%), 24 (26%), and 43 lesions (48%) in group A; 36 (40%), 28 (30%), and 27 lesions (30%) in group B; and 34 (37%), 39 (42%), and 19 lesions (21%) in group C, respectively (p = 0.0022).Negative remodeling occurs commonly in coronary lesions with minimal reference segment disease. Negative remodeling is not just an “artifact” introduced by comparing lesions to diseased reference segments.