Analysis of coronary bifurcations by intravascular ultrasound and virtual histology.

BACKGROUND Regional differences in shear stress have been identified as reason for early plaque formation in vessel bifurcations. We aimed to investigate regional plaque morphology and composition using intravascular ultrasound (IVUS) and virtual histology (IVUS-VH) in coronary artery bifurcations. METHODS We performed IVUS and IVUS-VH studies at coronary bifurcations to analyze segmental plaque burden and composition of different segments in relation to their orientation to the bifurcation. RESULTS A total of 236 patients with a mean age of 59±11 years (69% male) were analyzed. Plaque burden was higher at the contralateral vessel wall facing the bifurcation compared to the ipsilateral vessel wall and this difference was true for proximal and distal segments (proximal: 37±12% and 45±15% for segments at the ipsilateral and contralateral vessel wall, respectively, p<0.001; distal: 37±10% and 47±15% for segments at the ipsilateral and contralateral vessel wall, respectively, p<0.001). In addition, these segments exhibited a higher proportion of dense calcium and a lower proportion of fibrous tissue and fibro fatty tissue. CONCLUSIONS Segments on the contralateral wall of the bifurcation which have previously been identified as regions with low shear stress not only exhibited a higher plaque burden, but also a higher degree of calcification.

[1]  B. Berk,et al.  Laminar shear stress: mechanisms by which endothelial cells transduce an atheroprotective force. , 1998, Arteriosclerosis, thrombosis, and vascular biology.

[2]  Antonio Colombo,et al.  Randomized Study to Evaluate Sirolimus-Eluting Stents Implanted at Coronary Bifurcation Lesions , 2004, Circulation.

[3]  P. Serruys,et al.  Plaque composition and its relationship with acknowledged shear stress patterns in coronary arteries. , 2006, Journal of the American College of Cardiology.

[4]  P. Serruys,et al.  Intravascular ultrasound and 3D angle measurements of coronary bifurcations , 2009, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[5]  Dick M. Goedhart,et al.  The SYNTAX score revisited: A reassessment of the SYNTAX score reproducibility , 2010, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[6]  A. Stuck,et al.  Sudden cardiac death in patients with silent myocardial ischemia after myocardial infarction (from the Swiss Interventional Study on Silent Ischemia Type II [SWISSI II]). , 2009, The American journal of cardiology.

[7]  Antonio Colombo,et al.  Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. , 2009, The New England journal of medicine.

[8]  E. Edelman,et al.  Role of endothelial shear stress in the natural history of coronary atherosclerosis and vascular remodeling: molecular, cellular, and vascular behavior. , 2007, Journal of the American College of Cardiology.

[9]  J. Moore,et al.  Dynamic curvature strongly affects wall shear rates in a coronary artery bifurcation model. , 2001, Journal of biomechanics.

[10]  S. Nakatani,et al.  Intravascular ultrasound evaluation of plaque distribution at curved coronary segments. , 1998, The American journal of cardiology.

[11]  A. Jeremias,et al.  Spatial orientation of atherosclerotic plaque in non-branching coronary artery segments. , 2000, Atherosclerosis.

[12]  K. Peterson,et al.  Atheroma morphology and distribution in proximal left anterior descending coronary artery: in vivo observations. , 1996, Journal of the American College of Cardiology.

[13]  P. Serruys,et al.  Plaque composition in the left main stem mimics the distal but not the proximal tract of the left coronary artery: influence of clinical presentation, length of the left main trunk, lipid profile, and systemic levels of C-reactive protein. , 2007, Journal of the American College of Cardiology.

[14]  A. Schoenenberger,et al.  Intravascular ultrasound-based left main coronary artery assessment: comparison between pullback from left anterior descending and circumflex arteries. , 2009, The Journal of invasive cardiology.

[15]  T. Karino,et al.  Flow patterns and spatial distribution of atherosclerotic lesions in human coronary arteries. , 1990, Circulation research.

[16]  P. Serruys,et al.  Restenosis rates following bifurcation stenting with sirolimus-eluting stents for de novo narrowings. , 2004, The American journal of cardiology.

[17]  N. Stergiopulos,et al.  Plaque-prone hemodynamics impair endothelial function in pig carotid arteries. , 2006, American journal of physiology. Heart and circulatory physiology.

[18]  D Saloner,et al.  Calculation of the magnetization distribution for fluid flow in curved vessels , 1996, Magnetic resonance in medicine.

[19]  C. Zarins,et al.  Carotid Bifurcation Atherosclerosis: Quantitative Correlation of Plaque Localization with Flow Velocity Profiles and Wall Shear Stress , 1983, Circulation research.

[20]  F. N. van de Vosse,et al.  Plaque and shear stress distribution in human coronary bifurcations: a multislice computed tomography study. , 2009, EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology.

[21]  P. Erne,et al.  Significant decrease in in-hospital mortality and major adverse cardiac events in Swiss STEMI patients between 2000 and December 2007. , 2009, Swiss medical weekly.

[22]  S. Toggweiler,et al.  PCI in acute left main disease: a paradigm shift or a new reality? , 2009, European heart journal.

[23]  R M Nerem,et al.  The study of the influence of flow on vascular endothelial biology. , 1998, The American journal of the medical sciences.

[24]  I. Iakovou,et al.  Clinical and angiographic outcome after implantation of drug-eluting stents in bifurcation lesions with the crush stent technique: importance of final kissing balloon post-dilation. , 2005, Journal of the American College of Cardiology.

[25]  P. Serruys,et al.  Evaluation of endothelial shear stress and 3D geometry as factors determining the development of atherosclerosis and remodeling in human coronary arteries in vivo. Combining 3D reconstruction from angiography and IVUS (ANGUS) with computational fluid dynamics. , 1997, Arteriosclerosis, thrombosis, and vascular biology.

[26]  S. Alper,et al.  Hemodynamic shear stress and its role in atherosclerosis. , 1999, JAMA.

[27]  D. Vince,et al.  Automated coronary plaque characterisation with intravascular ultrasound backscatter: ex vivo validation. , 2007, EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology.

[28]  M. Kaazempur-Mofrad,et al.  Characterization of the Atherosclerotic Carotid Bifurcation Using MRI, Finite Element Modeling, and Histology , 2004, Annals of Biomedical Engineering.

[29]  Rob Krams,et al.  Shear stress affects the intracellular distribution of eNOS: direct demonstration by a novel in vivo technique. , 2005, Blood.