Background: Accurately, characterizing plaques is critical for selecting the optimal intervention strategy for the left main coronary artery (LMCA) bifurcation. Coronary angiography cannot precisely assess the loca...Background: Accurately, characterizing plaques is critical for selecting the optimal intervention strategy for the left main coronary artery (LMCA) bifurcation. Coronary angiography cannot precisely assess the location or nature of plaques in bifurcation lesions. Few intravascular ultrasound (IVUS) classification scheme has been reported for angiographic imaging of true bifurcation lesions of the unprotected LMCA thus far. In addition, the plaque composition at the bifurcation has not been elucidated. This study aimed to detect plaque composition at LMCA bifurcation lesions by IVUS. Methods: Fifty-eight patients were recruited. The location, concentricity or eccentricity, site of maximum thickness, and composition of plaques of the distal LMCA, ostial left anterior descending (LAD) coronary artery and, left circumflex (LCX) coronary artery were assessed using IVUS and described using illustrative diagrams. Results: True bifurcation lesions of the unprotected LMCA were classified into four types: Type A, with continuous involvement from the distal LMCA to the ostial LAD and the ostial LCX with eccentric plaques; Type B, with concentric plaques at the distal LMCA, eccentric plaques at the ostial LAD, and no plaques at the LCX; Type C, with continuous involvement from the distal LMCA to the ostial LCX, with eccentric plaques, and to the ostial LAD, with eccentric plaques; and Type D, with continuous involvement from the distal LMCA to the ostial LAD, with eccentric plaques, and to the ostial LCX, with concentric plaques. The carina was involved in only 3.5% of the plaques. A total of 51.7% of the plaques at the ostium of the LAD were soft, while 44.8% and 44.6% were fibrous in the distal LMCA and in the ostial LCX, respectively. Conclusions: We classified LMCA true bifurcation lesions into four types. The carina was always free from disease. Plaques at the ostial LAD tended to be soft, whereas those at the ostial LCX and the distal LMCA tended to be fibrous.展开更多
To the Editor:A 71-year-old male was admitted to the hospital for progressive exertional dyspnea.He had a history of fibrosing mediastinitis(FM)-induced pulmonary vascular stenosis.His right interlobar pulmonary arter...To the Editor:A 71-year-old male was admitted to the hospital for progressive exertional dyspnea.He had a history of fibrosing mediastinitis(FM)-induced pulmonary vascular stenosis.His right interlobar pulmonary artery had been severely stenosed and implanted with a 6-mm diameter stent(6 mm×18 mm;PALMAZ®BLUETX1,Cordis,Shanghai,China)6 months before admission,and his left superior pulmonary vein had been implanted with a 9-mm diameter stent(9 mm×29 mm;Express1 M Vascular LD,Boston Scientific,Marlborough,MA,USA)1 month before admission.展开更多
文摘Background: Accurately, characterizing plaques is critical for selecting the optimal intervention strategy for the left main coronary artery (LMCA) bifurcation. Coronary angiography cannot precisely assess the location or nature of plaques in bifurcation lesions. Few intravascular ultrasound (IVUS) classification scheme has been reported for angiographic imaging of true bifurcation lesions of the unprotected LMCA thus far. In addition, the plaque composition at the bifurcation has not been elucidated. This study aimed to detect plaque composition at LMCA bifurcation lesions by IVUS. Methods: Fifty-eight patients were recruited. The location, concentricity or eccentricity, site of maximum thickness, and composition of plaques of the distal LMCA, ostial left anterior descending (LAD) coronary artery and, left circumflex (LCX) coronary artery were assessed using IVUS and described using illustrative diagrams. Results: True bifurcation lesions of the unprotected LMCA were classified into four types: Type A, with continuous involvement from the distal LMCA to the ostial LAD and the ostial LCX with eccentric plaques; Type B, with concentric plaques at the distal LMCA, eccentric plaques at the ostial LAD, and no plaques at the LCX; Type C, with continuous involvement from the distal LMCA to the ostial LCX, with eccentric plaques, and to the ostial LAD, with eccentric plaques; and Type D, with continuous involvement from the distal LMCA to the ostial LAD, with eccentric plaques, and to the ostial LCX, with concentric plaques. The carina was involved in only 3.5% of the plaques. A total of 51.7% of the plaques at the ostium of the LAD were soft, while 44.8% and 44.6% were fibrous in the distal LMCA and in the ostial LCX, respectively. Conclusions: We classified LMCA true bifurcation lesions into four types. The carina was always free from disease. Plaques at the ostial LAD tended to be soft, whereas those at the ostial LCX and the distal LMCA tended to be fibrous.
基金a grant from the National Natural Science Foundation of China(Nos.81770300,81860059,81460072,82070052)Chinese Academy of Sciences“Light of West China”Program,International Joint Research Program of Gansu Province(No.18YF1WA046)+1 种基金Innovation and Entrepreneurship Program of Lanzhou City(No.2018-RC-78)the Science Foundation of Gansu Provincial Hospital(No.18GSSY5-4).
文摘To the Editor:A 71-year-old male was admitted to the hospital for progressive exertional dyspnea.He had a history of fibrosing mediastinitis(FM)-induced pulmonary vascular stenosis.His right interlobar pulmonary artery had been severely stenosed and implanted with a 6-mm diameter stent(6 mm×18 mm;PALMAZ®BLUETX1,Cordis,Shanghai,China)6 months before admission,and his left superior pulmonary vein had been implanted with a 9-mm diameter stent(9 mm×29 mm;Express1 M Vascular LD,Boston Scientific,Marlborough,MA,USA)1 month before admission.