Author + information
- Received January 23, 1995
- Revision received October 24, 1995
- Accepted November 2, 1995
- Published online March 15, 1996.
- Bruce J. Kimura, MDa,
- Robert J. Russo, MD, PhD∗,
- Valmik Bhargava, PhD, FACC†,
- Martin B. McDaniel, BA‡,
- Kirk L. Peterson, MD, FACCa and
- Anthony N. DeMaria, MD, FACC∗∗,a
- ↵∗∗Address for correspondence: Dr. Anthony N. DeMaria, Chief, Division of Cardiovascular Medicine, University of California-San Diego Medical Center, MC 8411, 200 West Arbor Street, San Diego, California 92103.
Objectives. This study sought to examine, in vivo, the shape and position of atheroma in the proximal left anterior descending coronary artery.
Background. The prevalence, shape and location of atheromas involving the proximal left anterior descending artery have implications regarding the role of disturbed shear forces in the genesis of atherosclerosis. However, no data are available regarding in vivo findings or advanced disease.
Methods. Forty-two consecutive high quality intravascular ultrasound images were examined from patients with atherosclerotic disease in the proximal left anterior descending artery just distal to the left main bifurcation. Lesion percent area stenosis and maximal, minimal and flow divider intimal-medial thickness were measured at the region immediately after the circumflex takeoff. The angle formed by the midpoint of the flow divider, the lumen center of gravity and the maximal plaque thickness were determined.
Results. Eccentricity of vessel wall atheroma was observed such that the maximal wall thickness (1.42 ± 0.50 mm [mean ± SD]) differed significantly from minimal wall thickness (0.17 ± 0.098 mm). Further, the region of vessel wall manifesting maximal thickness was greater than the flow divider thickness (0.26 ± 0.17 mm). Maximal plaque thickness spared the region of the flow divider in 100% of cases and was positioned at a mean angle of 193 ± 49° from the center of the flow divider. Eccentric morphology was maintained across the 24% to 80% range of area stenosis.
Conclusions. Atheromas in the very proximal left anterior descending artery are located opposite the circumflex takeoff, spare the flow divider and maintain eccentricity across a wide range of vessel stenoses. These in vivo morphologic data support the potential role of fluid dynamic mechanical factors in atherogenesis and have implications regarding the success of catheter-based interventional procedures at the site.
☆ This study was supported in part by the Hewitt Medical Research Foundation, Newport Beach and the San Diego Foundation for Cardiovascular Research and Education, San Diego, California.
- Received January 23, 1995.
- Revision received October 24, 1995.
- Accepted November 2, 1995.