Analysis of coronary bifurcations by intravascular ultrasound and virtual histology

Toggweiler, Stefan; Urbanek, Nadja; Schoenenberger, Andreas W.; Erne, Paul

doi:10.1016/j.atherosclerosis.2010.06.045

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Volume 212, Issue 2 , Pages 524-527, October 2010

Analysis of coronary bifurcations by intravascular ultrasound and virtual histology

Stefan Toggweiler
- Department of Cardiology, Luzerner Kantonsspital, CH-6000 Luzern 16, Switzerland
- These authors equally contributed to the manuscript.
Nadja Urbanek
- Department of Geriatrics and Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
- These authors equally contributed to the manuscript.
Andreas W. Schoenenberger
- Department of Geriatrics and Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
Paul Erne
- Department of Cardiology, Luzerner Kantonsspital, CH-6000 Luzern 16, Switzerland
- Corresponding author. Tel.: +41 412055106; fax: +41 412052234.

Received 21 March 2010; received in revised form 13 May 2010; accepted 29 June 2010. published online 27 July 2010.

Abstract

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.

Keywords: Atherosclerosis, Shear stress, Bifurcations, Coronary artery disease, IVUS