Vascular remodeling at both branch ostia in bifurcation disease assessed by intravascular ultrasound

Abstract

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.