Document Detail

Intravascular ultrasound assessment of distal left main bifurcation disease: The importance of the polygon of confluence of the left main, left anterior descending, and left circumflex arteries.
MedLine Citation:
PMID:  21805589     Owner:  NLM     Status:  Publisher    
BACKGROUND: The polygon of confluence (POC) represents the zone of confluence of the distal left main (LM), ostial left anterior descending [LAD], and ostial left circumflex [LCX] arteries. METHODS: We used intravascular ultrasound (IVUS) to assess the POC pre and post-drug-eluting stent implantation for unprotected distal LM disease. Four segments within 82 LM bifurcation lesions were defined by longitudinal IVUS reconstruction: (1) ostial LAD, (2) POC, and (3) distal LM (DLM) - from LAD-pullback and (4) ostial LCX from LCX-pullback. RESULTS: Pre-procedural minimum lumen area (MLA) and post-stenting minimum stent area (MSA) within the LM were mainly located within the POC (51% and 71%). On ROC analysis, a cut-off of the MLA within the POC of 6.1mm(2) predicted significant LCX carinal stenosis (85% sensitivity, 52% specificity, AUC=0.7, 95% CI=0.57-0.78, p<0.01). Post-stenting MSA within the distal LM proximal to the carina (to include DLM and POC) positively correlated with the pre-procedural MLA within the POC (r=0.283, p=0.02); it was significantly smaller in 48 lesions with a pre-PCI MLA within the POC <6.1mm(2) versus 25 lesions with a pre-PCI MLA ≥6.1mm(2) (7.5±2.1mm(2) vs. 8.6±2.0mm(2) , p=0.04). Independent predictors for post-stenting LCX carinal MLA also included pre-procedural MLA within the POC (β=0.240, 95% CI=0.004-0.353, p=0.04). CONCLUSION: The MLA within the POC was a good surrogate reflecting the overall severity of LM bifurcation disease including ostial LCX stenosis pre-PCI and the ability to expand a stent within the distal LM as well as final ostial LCX lumen area post-PCI. © 2011 Wiley-Liss, Inc.
Soo-Jin Kang; Gary S Mintz; Jun-Hyok Oh; Duk-Woo Park; Seung-Whan Lee; Young-Hak Kim; Cheol Whan Lee; Seong-Wook Park; Seung-Jung Park
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-7-29
Journal Detail:
Title:  Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions     Volume:  -     ISSN:  1522-726X     ISO Abbreviation:  -     Publication Date:  2011 Jul 
Date Detail:
Created Date:  2011-8-1     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100884139     Medline TA:  Catheter Cardiovasc Interv     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011 Wiley-Liss, Inc.
Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
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