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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
Author(s) -
Kang SooJin,
Mintz Gary S.,
Oh JunHyok,
Park DukWoo,
Lee SeungWhan,
Kim YoungHak,
Lee Cheol Whan,
Park SeongWook,
Park SeungJung
Publication year - 2013
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.23263
Subject(s) - medicine , circumflex , intravascular ultrasound , gauche effect , left behind , confluence , cardiology , anatomy , artery , psychiatry , computer science , mental health , programming language
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 : Preprocedural minimum lumen area (MLA) and poststenting 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 6.1 mm 2 predicted significant LCX carinal stenosis (85% sensitivity, 52% specificity, AUC = 0.7, 95% CI = 0.57–0.78, P < 0.01). Poststenting MSA within the distal LM proximal to the carina (to include DLM and POC) positively correlated with the preprocedural 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 < 6.1 mm 2 versus 25 lesions with a pre‐PCI MLA ≥6.1 mm 2 (7.5 ± 2.1 mm 2 vs. 8.6 ± 2.0 mm 2 , P = 0.04). Independent predictors for poststenting LCX carinal MLA also included preprocedural 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 Periodicals, Inc.