Quantitative flow ratio and intravascular ultrasound guided percutaneous coronary intervention of left anterior descending lesion concomitant with severe coronary myocardial bridge

Severe coronary stenosis concomitant with congenital coronary myocardial bridge(MB)is a tough scenario for cardiologist to perform revascularization,for which the complication rates including in-stent restenosis,stent fracture,stent thrombosis and even coronary perforation are still high.[1,2]Meanwhile,the necessity of revascularization in such patients is worth prudent evaluation.Cardiac imaging modalities are crucial and helpful in making revascularized decisions and strategies.Herein,we report a case using quantitative flow ratio(QFR)and intravascular ultrasound(IVUS)to facilitate accurate revascularization in a patient with both severe coronary stenosis and deep coronary MB.

The potential value of intravascular ultrasound imaging in diagnosis of aortic intramural hematoma

Objective To evaluate the potential value of intravascular ultrasound(IVUS)imaging in the diagnosis of aortic intramural hematoma(AIH).Methods From September 2002 to May 2005,a consecutive series of 15 patients with suspected aortic dissection(AD)underwent both IVUS imaging and spiral computed tomography(CT).Six patients diagnosed as acute type B AIH by CT or IVUS composed the present study group.Results The study group consisted of five males and one female with mean age of 66 years old.All of them had chest or back pain.In one patient,CT omitted a localized AIH and an associated penetrating atherosclerotic ulcer(PAU),which were detected by IVUS.In another patient,CT mistaken a partly thrombosed false lumen as an AIH,whereas IVUS detected a subtle intimal tear and slow moving blood in the false lumen.In the four rest patients,both CT and IVUS made the diagnosis of AIH,however,IVUS detected three PAUs in three of them,only one of them was also detected by CT,and two of them escaped initial CT and were confirmed by follow up CT or magnetic resonance imaging.Conclusions IVUS imaging is a safe examination and has high accuracy in the diagnosis of AIH,particularly for diagnosing localized AIH,distinguishing AIH with thrombosed classic AD and detecting accompanied small PAUs.

Spontaneous multivessel coronary artery spasm diagnosed with intravascular ultrasound imaging:A case report

BACKGROUND Coronary artery spasm is a major cause of myocardial ischemia.Although coronary artery spasm has been known for a long time,its mechanism has not yet been identified.Many clinicians,especially young clinicians pay less attention to coronary artery spasm,which may lead to some patients not being appropriately diagnosed and treated in time.We report a patient with spontaneous multivessel coronary artery spasm for more than 30 years diagnosed with intravascular ultrasound(IVUS)imaging.CASE SUMMARY A 66-year-old Chinese male patient had chest squeezing at rest for more than 30 years.He had a history of cigarette smoking for more than 40 years and hypertension for 10 years.Before presenting at our institution,the patient had undergone coronary angiography 4 times and percutaneous transluminal coronary angioplasty procedures twice at other hospitals without a diagnosis of coronary artery spasm.However,his chest symptoms worsened.Spontaneous multivessel coronary artery spasm occurred during IVUS without provocation testing,and the IVUS image was recorded.Thus,the diagnosis of multifocal spontaneous coronary artery spasm was confirmed.The patient was placed on oral diltiazem,isosorbide mononitrate,and nicorandil to suppress coronary artery spasms.All medications were given at the maximum dosages tolerated by the patient.He was discharged after 5 d without complications.During the six-month follow-up period,the patient was symptom-free.CONCLUSION Coronary artery spasm is still prevalent in Eastern countries.It is essential for clinicians to be aware of coronary artery spasm,which may be hard to detect and can be lethal,in order to diagnose and treat patients appropriately.

Clinical study on the correlation between plasma lipopolysaccharide and the structural characteristics of coronary intravascular ultrasound plaques

Objective:To study the correlation between plasma lipopolysaccharide and coronary atherosclerotic heart disease risk factors and plaque stability.Methods:136 patients with unstable angina pectoris who underwent coronary angiography and intravascular ultrasound were selected from the First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine.According to the results of IVUS,they were divided into stable plaques(stable plaques,SP)group of 72 patients With 64 cases in the Unstable plaques(UP)group,venous blood was drawn from the two groups of patients for blood lipid and lipopolysaccharide index detection,and the general baseline data of the two groups were recorded;the structural characteristics of the intravascular ultrasound plaques in the two groups were analyzed.To study the influencing factors of unstable plaques,the correlation between lipopolysaccharide and plaque structural characteristics,and the diagnostic efficacy of unstable plaques.Results:The expression levels of cholesterol,low-density lipoprotein,and LPS in the UP group were higher than those in the SP group(P<0.05),and the high-density lipoprotein expression levels were lower than those in the SP group(P=0.035);and the intravascular ultrasound structure of the plaque was UP The lipid pool area,the ratio of lipid pool to plaque area,the plaque eccentricity index,and the maximum plaque thickness of the group were higher than those of the SP group(P<0.05),and the minimum plaque thickness was smaller than that of the SP group and the difference was statistically significant(P<0.05);LPS was positively correlated with cholesterol,low-density lipoprotein,lipid pool area,ratio of lipid pool to plaque area,plaque eccentricity index,and maximum plaque thickness by Pearson correlation test(P<0.05),Is negatively correlated with high-density lipoprotein(P=0.021);LPS is a risk factor for coronary plaque stability,and HDL is a protective factor for coronary plaque stability by binary logistic regression test.The difference is statistically significant Scientific significance(P=0.049,P=0.002);LPS diagnosis of coronary atherosclerotic plaque stability ROC area under the curve(AUC)is 0.889,95%CI is(0.805,0.974),the best diagnosis point is 57.485 mg/L,the sensitivity is 80.60%,and the specificity is 73.70%.Conclusion:Plasma lipopolysaccharide is a risk factor of unstable plaque,which has certain diagnostic value for coronary artery plaque,and can be used as a quantitative diagnostic index of plaque vulnerability.

Efficacy of intravascular ultrasound-guided percutaneous coronary intervention in patients with acute myocardial infarction

Background The intravascular ultrasound(IVUS)-guided percutaneous coronary intervention(PCI)can benefit the treatment of coronary artery disease(CAD).However,the beneficial effect of IVUS-guided PCI in patients with acute myocardial infarction(AMI)remains controversial.Methods A total of 537 AMI patients were included in this study,divided into two groups:the angiography-guided group(n=289)and the IVUS-guided group(n=248)according to whether the IVUS was applied.The primary outcome was a composite of major adverse cardiovascular events(MACEs),including cardiovascular death,recurrent myocardial infarction(MI),and target lesion revascularization(TLR).The secondary outcome was procedural radiation exposure time.Results The IVUS-guided group was associated with a reduced incidence of MACEs(12.8%vs.8.5%,P=0.032).The results were consistent after adjusting for confounders in the multivariable Cox analysis,which showed that the absence of IVUS(HR 1.194,95%CI 1.061-1.323,P=0.011)was an independent predictor of MACEs.Additionally,the IVUS-guided group experienced significantly lower float time(893.3±265.2 min vs.623.2±137.3 min,P<0.001).Conclusions The use of IVUS was associated with better long-term cardiovascular outcomes.The use of IVUS in PCI should be considered for patients with AMI to optimize procedural outcomes and enhance long-term prognosis.

冠心病患者血清半乳糖凝集素3水平与冠状动脉斑块成分的相关性分析

目的通过血管内超声-虚拟组织学成像技术(VH-IVUS)分析冠心病患者的斑块成分,并研究斑块性质与血清半乳糖凝集素3(galectin-3)的相关性。方法冠心病患者257例,其中稳定型心绞痛(SA)85例,急性冠状动脉综合征(ACS)172例,对照组120例,均行冠状动脉造影检查,造影结果符合冠心病诊断标准的患者进一步行血管内超声检查,记录灰阶和VH-IVUS(VH-IVUS)相关数据,检测患者血清中半乳糖凝集素3、高敏C反应蛋白(hs-CRP)水平,分析其与斑块成分相关性。结果 3组患者的一般资料差异无显著性;ACS组血管重塑指数、坏死核心(NC)、斑块偏心指数均高于SA组,差异有统计学意义(P<0.05),斑块中纤维脂质(FF)与纤维组织(FT)比例均低于SA组,差异有统计学差异(P<0.05)。ACS组患者血清半乳糖凝集素。hs-CRP水平明显高于SA组及对照组,差异有统计学意义(P<0.05)。在ACS患者,血清半乳糖凝集素3水平与斑块中NC所占比例、斑块偏心指数、血管重塑指数呈正相关(r=0.632,P=0.017;r=0.640,P=0.020;r=0.615,P=0.021)。结论 ACS斑块多为偏心性斑块、斑块中坏死核心比例较大,SA斑块多由纤维组织或纤维脂肪组织构成;血清半乳糖凝集素3、hs-CRP水平与斑块中坏死核心所占比例、斑块偏心指数、血管重塑指数呈明显正相关。

血管内超声诊断设备性能测试研究

血管内超声成像设备是一种专用的超声检测设备,对其性能检测目前没有合适的参考标准。本文参照GB10152-2009对B型超声诊断设备的要求,对血管内超声成像系统的分辨力和中心频率两个指标参数开展研究,确定检测方法并建立测试系统,最后对中心频率及分辨力等性能指标进行了测试验证。本研究为血管内超声成像设备检测规范的建立提供了很好的基础。

基于CORDIC算法的血管内超声成像系统数字坐标转换的FPGA实现

为了方便医生利用血管内超声成像系统更好地获取心血管图像,做出更加精准的诊断,该研究提出了一种基于CORDIC算法的血管内超声成像系统的数字坐标转换方法,通过角度旋转和定向计算将极坐标转换为直角坐标。利用FPGA在血管内超声成像系统平台上进行实验仿真测试,实验仿真表明,CORDIC算法能有效地输出正余弦值,与传统的查找表方法相比,速度更快,实时性更强,消耗硬件资源少,更适用于血管内超声成像系统。

血管内超声成像系统的旋转控制装置优化设计研究

为了便于医生对新血管病变做出更为全面和精准的评价,促使超声成像系统国产化及低成本化,提出一种应用于血管内超声成像系统的新型旋转控制装置的优化设计方案,设计方案提升了装置的角度检测性能和传动性能。该装置成本较低、易于操作,可实现从旋转的血管内导管及超声换能器到非旋转接收端的信号传递,同时测算出超声换能器的旋转角度实行角度检测,最后将血管内超声信号经成像系统处理后获得血管壁图像。通过搭建血管内超声成像系统来进行仿真实验,实验结果表明该装置能有效检测出血管壁图像并辅助实现血管内的超声检测,这为血管内超声成像系统国产化的发展提供了新的技术依据。

Relationship between plasma cathepsin S and cystatin C levels and coronary plaque morphology of mild to moderate lesions： an in vivo study using intravascular ultrasound

Background Cathepsin S and its endogenous inhibitor cystatin C are implicated in the pathogenesis of atherosclerosis, especially in the plaque destabilization and rupture leading to acute coronary syndrome. However, whether circulating cathepsin S and cystatin C also change in association with coronary plaque morphology is unknown yet. Methods We recruited 98 patients with unstable angina （UA, n=56） or stable angina （SA, n=-42） who had a segmental stenosis resulting in 〉20% and 〈70% diameter reduction in one major coronary artery on coronary angiography. Thirty-one healthy subjects served as controls. Intravascular ultrasound （IVUS） was used to evaluate plaque morphology. Plasma cathepsin S and cystatin C were measured as well. Results At the culprit lesion site, plaque area （（7.85±2.83） mm^2 vs （6.53±2.92） mm^2, P=0.027）, plaque burden （（60.92±11.04）% vs （53.87±17.52）%, P=0.025）, remodeling index （0.93±0.16 vs 0.86±0.10, P=0.004） and eccentricity index （0.74±0.17 vs 0.66±0.21, P=0.038） were bigger in UA group than in SA group. Plasma cathepsin S and cystatin C were significantly higher in patients than in controls （P〈0.01）. Plasma cathepsin S was higher in UA group （（0.411±0.121） nmol/L） than in SA group （（0.355±0.099） nmol/L, P=0.007）, so did the plasma cystatin C （（0.95±0.23） mg/L in UA group, （0.84±0.22） mg/L in SA group; P=0.009）. Plasma cathepsin S positively correlated with remodeling index （r=0.402, P=0.002） and eccentricity index （r=0.441, P=0.001）, and plasma cystatin C positively correlated with plaque area （r=0.467, P 〈0.001） and plaque burden （r=0.395, P=0.003） in UA group but not in SA group. Conclusions Plasma cathepsin S and cystatin C increased significantly in UA patients. In angina patients, higher plasma cathepsin S may suggest the presence of vulnerable plaque, and higher plasma cystatin C may be a clue for larger atherosclerotic coronary plaque.

Relationship among soluble CD105, hypersensitive C-reactive protein and coronary plaque morphology： an intravascular ultrasound study

Background Rupture of unstable plaque with subsequent thrombus formation is the common pathophysiological substrate of acute coronary syndrome （ACS）. It is of potential significance to explore the blood indexes predicting plaque characteristics. We investigated the relationship among soluble CD105, hypersensitive C-reactive protein （hs-CRP）, and coronary plaque morphology.Methods A clinical study from April 2004 to December 2006 was conducted in 130 patients who were divided into 3 groups： 56 patients （43.1%） in stable angina （SA） group, 52 patients （40.0%） in unstable angina （UA） group and 22 patients （16.9%） in acute myocardial infarction group. The concentrations of soluble CD105 and hs-CRP were measured in all of the patients by cardioangiography （CAG）. Plasma samples of arterial blood were collected prior to the procedure. The levels of soluble CD105 and hs-CRP were measured by enzyme-linked immunosorbent assay （ELISA）.Results Unstable and ruptured plaque was found more frequently in patients with acute myocardial infarction and UA. External elastic membrane cross-sectional area （EEM CSA）, plaque area, lipid pool area and plaque burden were significantly larger in the ruptured and unstable plaque group. Positive remodeling, thinner fabric-cap, smaller minimal lumen cross-sectional area （MLA）, dissection and thrombus were significantly more frequent in the ruptured and unstable plaque group. Remodeling index （RI） was positively correlated with the levels of soluble CD105 in the UA group （r=0.628, P〈0.01） and the acute myocardial infarction group （r=0.639, P〈0.01）. The levels of soluble CD105 and hs-CRP were higher in the ruptured plaque group. Soluble CD105 〉4.3 ng/ml was used to predict ruptured plaque with a receiver operating characteristic （ROC） curve area of 0.77 （95% confidence interval （CI）, 66.8%-87.2%）, a sensitivity of 72.8%, a specificity of 78.0% and an accuracy of 70.2% （P〈0.01）, similarly for hs-CRP 〉 5.0 mg/ml with a ROC curve area of 0.70 （95% CI, 59.2%-80.2%）, a sensitivity of 70.2%, a specificity of 76.2% and an accuracy of 67.2% （P〈0.01）.Conclusions The plaque characteristics correlate with the clinical presentation. The elevation of soluble CD105 and hs-CRP is related to the plaque instability and rupture.

Myocardial bridging detection by non-invasive multislice spiral computed tomography： comparison with intravascular ultrasound

Background Invasive intravascular ultrasound （IVUS） is current diagnostic standard for myocardial bridging （MB）. Non-invasive multislice computerized tomography coronary angiography （MSCT） technique has provided a good anatomical view of the tunnel artery now. Methods A total of 51 consecutive patients with atypical or typical angina scheduled for IVUS were enrolled in this study and MSCT was performed 7 days before IVUS. Coronary imaging was quantified using IVUS and MSCT. Four main vessels （left main artery （LMA）, left anterior descending （LAD）, left circumflex （LCX）, right coronary artery （RCA）） were examined. Results Forty-one out of 51 （80%） patients received metaprolol （25 mg） before the MSCT scan and 25 of them were current beta-blocker users. The mean heart rate was （64_＋3） beats per minute. A total of 51 patients underwent IVUS examination （30 with MB and 21 without MB） were chosen for this study. Twenty-eight out of 30 MB cases were correctly diagnosed by MSCT and 2 patients with MB were not detected. Comparison with IVUS, the sensitivity of detection by MSCT was 93%, specificity was 100%. The lumen diameter of the tunnel artery derived from MSCT and IVUS significantly decreased from （2.9±0.3） mm to （2.4±0.4） mm （P〈0.001） and from （3.3±0.3） mm to （2.6±0.5） mm （P〈0.001）, respectively. Minimal and maximal diameters of MB derived from MSCT were significantly smaller than those from IVUS （（2.4±0.4） mm vs （2.6±0.5） mm, P〈0.05 and （2.9±0.3） mm vs （3.3±0.3） mm, P〈0.05）, respectively. Conclusions MSCT offers a reliable non-invasive method for MB in LAD and atherosclerosis diagnosis with diagnostic accuracy comparable with invasive IVUS.

Optimized quantitative angiographic and intravascular ultrasound parameters predicting the functional significance of single de novo lesions in the left anterior descending artery

Background The correlation between angiographic or intravascular ultrasound （IVUS） variables and fractional flow reserve （FFR） in patients with single left anterior descending artery （LAD） lesion has not been studied. The current study aimed at determining the best cutoff value of angiographic and IVUS parameters for defining FFR 〈0.80 in patients with LAD lesion. Methods Quantitative coronary analysis, IVUS and FFR measurements were undergone in 169 patients with single LAD lesion, The best angiographic and IVUS cutoff value and their predictive value for FFR 〈0.80 were compared using area under the receiver-operator characteristic curve （AUC） in overall patients or in subgroups stratified by lesion sites. Results FFR 〈0.80 was found in 99 lesions （58.6%）. Minimal lumen area （MLA）, and plaque burden （PB） were two predictors of FFR 〈0.80. Lesion length had less value in predicting FFR 〈0.80. The cutoff value of PB and MLA for FFR 〈0.80 was 75.4% and 3.03 mm2. MLA and PB had similar high diagnostic value for proximal （cutoff value 3.04 mm2 and 76.5%） and distal LAD lesion （2.82 mm2 and 80.6%）. Combination of MLA （2.82 mm2） and PB （80.6%） had increased diagnostic value for distal LAD lesion. Conclusions MLA and plaque burden had equivalent diagnostic value for FFR 〈0.80 when lesion localized in LAD. The predictive value of combination of MLA and plaque burden for distal LAD lesion was strengthened.

Relationship between intravascular ultrasound imaging features of coronary plaques and soluble CD105 level in patients with coronary heart disease

Plaque rupture with subsequent thrombus formation is the common pathophysiological substrate of acute coronary syndrome （ACS）. Moreno et al reported mat neovascularization as manifested by the localized appearance of microvessels is increased in ruptured plaques in the human aorta. Microvessel density is also increased in inflammatory lesions, with intraplaque hemorrhage and in thin-cap fibroatheromas. Microvessels at the base of the plaque are independently correlated with plaque rupture, suggesting a contributory role for neovascularization in the process of plaque rupture. Soluble CD105, a sensitive serum marker of neovascularization, is thought to be associated with cardiovascular disease. The purpose of this study was to assess the relationship between the level of soluble CD105 and the morphological plaques by intravascular ultrasound （IVUS） in patients with stable angina （SA） and those with unstable angina （UA） and whether soluble CD105 may serve as a non-invasive marker of coronary plaque destabilization.

Quantitative and qualitative assessment of non-obstructive left main coronary artery plaques using 64-multislice computed tomography compared with intravascular ultrasound

Background There are few reports of quantitative and qualitative measuring of left main coronary artery （LMCA） plaques by multislice computed tomography coronary angiography （MSCTA）, especially when compared with intravascular ultrasound （IVUS） as reference standard. The aim of this study was to evaluate the use of 64-MSCTA in the diagnosis of LMCA disease, and the accuracy of MSCTA in the quantitative and qualitative assessment of the LMCA lesion as compared with IVUS.Methods A total of 91 patients （53 men, 38 women, mean age （64.78±9.19） years） were examined by 64-MSCTA and IVUS. Compared with the IVUS, the sensitivity, specificity, positive and negative predictive values （PPV and NPV） of the MSCTA on the diagnosis of LMCA diseases were calculated. Also, kappa index （K） for the agreement between MSCTA and IVUS was calculated. Minimal lumen area （MLA）, external elastic membrane cross-sectional area （EEM-CSA） and plaque burden were measured by two blinded and independent operators on MSCTA cross-sectional reconstruction and compared with the parameters measured from IVUS by manually tracing. The CT value of soft, fibrous and calcific plaques was measured using IVUS classification of the plaques.Results The sensitivity, specificity, PPV and NPV of MSCTA for detecting LMCA plaques were 93.1%, 84.2%, 95.7%, 76.2%, respectively. Kappa index （K=0.744, P〈0.001） indicated excellent agreement between MSCTA and IVUS. The Pearson index between MLA on IVUS and MLA on MSCTA was 0.815 （P 〈0.01）. The Pearson index of plaque burden and EEM-CSA between IVUS and MSCTA was 0.736 and 0.740 respectively （both P 〈0.01）. The CT value of soft plaque, fibrous plaque and calcific plaque compared with IVUS were （52.52±15.71） HU, （108.32±43.44） HU and （604.16±377.67） HU （P〈0.001）. Receiver operating characteristic curve analysis of CT value of non-calcific plaques for predicting soft plaques showed the cutpoint was 54.35 HU, with a sensitivity of 83.3% and specificity of 94.4%. Conclusions Sixty-four section MSCTA is an effective diagnostic tool for the detection of LMCA plaques with higher sensitivity and specificity. The correlation of quantitative and qualitative analysis between MSCTA and IVUS was excellent. The CT value of plaques can help the diagnosis of plaque composition.

Pattern of instent neointimal formation compared to native atherosclerosis in the coronary bifurcation lesions： volumetric intravascular ultrasound analysis

Background No clinical study has systematically analyzed and compared circumferential neointimal and plaque distribution of stent neointimal proliferation and in native atherosclerotic plaques. This study aimed to investigate and compare the pattern of instent neointimal formation and native atherosclerosis in the coronary bifurcation lesions by volumetric analysis using systematic intravascular ultrasound （IVUS）. Methods We examined bifurcation lesions in native coronary artery （plaque group, n=102） and stented bifurcations at 9-month follow-up （neointima group, n=51） using volumetric IVUS analysis of both the main vessel （MV） and side branch （SB）. Three 5-mm segments were analyzed; the proximal MV （MVp）, distal MV （MVd） and SB ostium （SBo）. For each segment, volumetric analysis was performed in each of four quadrants （divided according to the branch takeoff and the geometric center of the lumen）; carinal, epicardial, abcarinal, and myocardial. The eccentricity index was defined as the ratio of the abcarinal plaque （or neointimal） volume to the carinal plaque （or neointimal） volume. Results The plaque distribution differed significantly between the four quadrants, with the largest in the abcarinal quadrant, followed by the myocardial, epicardial, and carinal quadrants. The distribution of neointima was similar in the MV, but the four quadrants in the SB did not differ significantly. The eccentricity indices of both the MVd （P 〈0.001） and SBo （P=-0.001） were significantly higher for the plaque group than the neointima group. Conclusions The distribution of neointimal proliferation seems to have a similar pattern to that of atherosclerotic plaque in native coronary arteries. Darticularlv in the main vessel, but the trend is less prominent.

Long-term effects of biodegradable versus durable polymer-coated sirolimus-eluting stents on coronary arterial wall morphology assessed by virtual histology intravascular ultrasound

Background The durable presence of polymer coating on drug-eluting stent （DES） surface may be one of the principal reasons for stent thrombosis. The long-term coronary arterial response to biodegradable polymer-coated sirolimus-eluting stent （BSES） in vivo remained unclear.Methods Forty-one patients were enrolled in this study and virtual histology intravascular ultrasound （VH-IVUS） was performed to assess the native artery vascular responses to BSES compared with durable polymer-coated SES （DSES） during long-term follow-up （median： 8 months）. The incidence of necrotic core abutting to the lumen was evaluated at follow-up.Results With similar in-stent late luminal loss （0.15 mm （0.06-0.30 mm） vs. 0.19 mm （0.03-0.30 mm）, P=0.772）, the overall incidence of necrotic core abutting to the lumen was significantly less in BSES group than in DSES group （44% vs.63%, P 〈0.05） （proximal 18%, stented site 14% and distal 12% in BSES group, proximal 19%, stented site 28% and distal 16% in DSES group）. The DSES-treated segments had a significant higher incidence of necrotic core abutting to the lumen through the stent struts （73% vs. 36%, P 〈0.01）. In addition, more multiple necrotic core abutting to the lumen was observed in DSES group （overall： 63% vs. 36%, P 〈0.05）. Furthermore, when the stented segments with necrotic core abutting to the lumen had been taken into account only, DSES-treated lesions tended to contain more multiple necrotic core abutting to the lumen through the stent struts than BSES-treated lesions （74% vs. 33%）, although there was no statistically significant difference between them （P=0.06）.Conclusions By VH-IVUS analysis at follow-up, a greater frequency of stable lesion morphometry was shown in lesions treated with BSESs compared with lesions treated with DSESs. The major reason was BSES produced less toxicity to the arterial wall and facilitated neointimal healing as a result of polymer coating on DES surface biodegraded as time went by.

Intravascular Ultrasound Classification of Plaque in Angiographic True Bifurcation Lesions of the Left Main Coronary Artery

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.

Coronary bifurcation lesions treated with double kissing crush technique compared to classical crush technique： serial intravascular ultrasound analysis

Background The double kissing （DK） crush technique is a modified version of the crush technique. It is specifically designed to increase the success rate of the final kissing balloon post-dilatation, but its efficacy and safety remain unclear. Methods Data were obtained from the DKCRUSH-I trial, a prospective, randomized, multi-center study to evaluate safety and efficacy. Post-procedural and eight-month follow-up intravascular ultrasound （IVUS） analysis was available in 61 cases. Volumetric analysis using Simpson＇s method within the Taxus stent, and cross-sectional analysis at the five sites of the main vessel （MV） and three sites of the side branch （SB） were performed. Impact of the bifurcation angle on stent expansion at the carina was also evaluated. Results Stent expansion in the SB ostium was significantly less the DK crush group （（72.27±11.46）%） （P=0.04）. For the MV, the n the classical crush group （（53.81±13.51）%） than in ncidence of incomplete crush was 41.9% in the DK group and 70.0% in the classical group （P=0.03）. The percentage of neointimal area at the ostium had a tendency to be smaller in the DK group compared with the classical group （（16.4±19.2）% vs. （22.8±27.1）%, P=0.06）. The optimal threshold of post-procedural minimum stent area （MSA） to predict follow-up minimum lumen area （MLA） 〈4.0 mm2 at the SB ostium was 4.55 mm2, yielding an area under the curve of 0.80 （95% confidence interval： 0.61 to 0.92）. Conclusion Our data suggest that the DK crush technique is associated with improved quality of the final kissing balloon inflation （FKBI） and had smaller optimal cutoff value of post-procedural MSA at the SB ostium.

Usefulness of lumen area parameters determined by intravascular ultrasound to predict functional significance of intermediate coronary artery stenosis

Background Coronary artery disease is the leading cause of death in China. Percutaneous coronary intervention is a recent milestone technology for treatment coronary artery disease. However, clinical decision making for patients with intermediate coronary stenosis is still controversial. We designed this study to assess the optimal intravascular ultrasound （IVUS） criteria for predicting functional significance of intermediate coronary lesions. Methods We enrolled 141 patients with 165 intermediate coronary lesions located in vessels with a diameter 〉2.50 mm. IVUS of intermediate coronary lesions were performed before intervention. Pressure-derived fractional flow reserve （FFR） was measured at maximal hyperemia induced by adenosine infusion. An FFR 〈0.80 was considered as abnormal functional significance. Results For the overall 165 lesions, the mean FFR value was 0.84±0.09. The diameter of the stenosis by visual estimation on angiogram was （59.63±11.29）%. Minimum lumen diameter （MLD）, minimum lumen area （MLA） and plaque burden （PB） were （2.00±0.36） mm, （3.88±1.34） mm2, （67.28±9.89）% respectively by IVUS measurements. An FFR 〈0.80 was seen in 43 lesions （30.5%）. There was a moderate correlation between IVUS parameters and FFR, including MLD （r=0.372, P 〈0.001 ）, MLA （r=0.442, P 〈0.001 ） and PB （t=-0.172, P 〈0.05）. MLA was a predictor for FFR as a continuous variable independent of possible confounding variables （P 〈0.05）, and MLA and PB, were predictors for FFR 〈0.80 as binary variables （P 〈0.05）. The best cutoff value of MLA to predict FFR 〈0.80 was 〈3.15 mm2, with a 73.6% diagnostic accuracy; sensitivity 71.4%, specificity 67.0%, AUC=0.709, and P 〈0.001. The cutoff value of the PB to predict FFR 〈0.80 was 65.45%; sensitivity 82.6%, specificity 41.2%, AUC=0.644, and P 〈0.01. If both MLA and PB were taken into account, the negative predictive value and the positive predictive value were 88.7% and 64.8% respectively. Conclusions Anatomic measurements of intermediate coronary lesions obtained by IVUS showed a moderate correlation to FFR values. IVUS-derived MLA 〉3.15 mm2 may be useful to exclude FFR 〈0.80, but poor specificity limits its applicability for physiological assessment of lesions 〈3.15 mm2. MLA was one of many factors affecting coronary flow hemodynamics. Both MLA and PB should be taken into account when determining functional ischemia.