Extent of atherosclerosis and remodeling of the left main coronary artery determined by intravascular ultrasound

This study used intravascular ultrasound (IU) to assess the incidence and extent of left main coronary artery (LMCA) disease and the effects of arterial remodeling. Sixty-nine patients undergoing cardiac catheterization were imaged with a 20 MHz rotational-tip IU device. Nine of the 69 studies (13%) could not be analyzed because of technical (n = 2) or anatomic (n = 7) reasons. Of the remaining 60 patients, 38 (63%) had at least 1 lesion in the left coronary artery perfusion territory by angiography; significant LMCA stenosis was present in 2 patients (3%). Intravascular ultrasonography demonstrated plaques in 27 of 60 LMCAs (45%), 6 of them in patients with normal angrograms. Twenty-four plaques (89%) were eccentric and calcium was present in 4 (15%). The mean minimal lumen diameter was 4.9 ± 0.8 mm, the maximal lumen diameter was 5.6 ± 0.8 mm, the planimetered lumen area was 22.6 ± 6.0 mm2, the plaque area was 3.9 ± 5.8 mm2, the vessel area was 26.5 ± 5.9 mm2, and the area stenosis was 13 ± 19%. In the 27 patients with plaque, plaque area was 8.7 ± 5.7 mm2 and the area stenosis was 30 ± 17%. The vessel area was significantly larger in diseased LMCAs (p < 0.001) and correlated with plaque area (r = 0.46). Iu examination of the LMCA was feasible in 87% of patients and was more reliable for delineating plaques than angiogaphy.