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DIFFERENT PATTERNS OF CHRONIC TOTAL OCCLUSIONS IN THE RIGHT AND LEFT CORONARY ARTERIES: AN INTRAVASCULAR ULTRASOUND STUDY
E102 JACC March 27, 2012 Volume 59, Issue 13
ACC-i2 with TCT DIFFERENT PATTERNS OF CHRONIC TOTAL OCCLUSIONS IN THE RIGHT AND LEFT CORONARY ARTERIES: AN INTRAVASCULAR ULTRASOUND STUDY i2 Poster Contributions McCormick Place South, Hall A Saturday, March 24, 2012, 9:30 a.m.-Noon
Session Title: Chronic Total Occlusions Abstract Category: 11. PCI - Chronic Total Occlusions Presentation Number: 2526-414 Authors: Tadayuki Yakushiji, Akiko Maehara, Araki Hiroshi, Shigeo Saito, Martin Leon, Gregg Stone, Jeffrey Moses, Gary Mintz, Masahiko Ochiai, Cardiovascular Research Foundation, New York, NY, USA, Showa University Northern Yokohama Hospital, Yokohama, Japan Background: The anatomic pattern and length of a chronic total occlusion (CTO) may not be accurately evaluable by angiography. Methods: We used intravascular ultrasound (IVUS) to evaluate 178 CTO lesions after guidewire penetration without long (>10mm) false lumen wiring or hematoma to assess patterns of plaque distribution. Patterns were either 1) multi-focal: ≥2 separate occlusions separated by nonoccluded segment or 2) continuous: no non-occluded segment. Results: CTO was located in the RCA in 41%, LAD in 39%, and LCX in 20%. A sidebranch <5mm from the CTO end was observed in 82.1% of proximal and 62.8% of distal sites with only 25% of CTOs having a sidebranch originating within the CTO. IVUS showed a multi-focal pattern in 22 (12.4%) lesions that was more prevalent in the RCA (68%) vs the LAD (27%) and LCX (5%). A multi-focal pattern was more often associated with longer CTO length >20mm than shorter CTO length ≤20mm (64% vs 9%, p<0.001) and a sidebranch originating inside of the CTO (77% vs 18%, p<0.001). In general, RCA CTOs appeared long and multi-focal while the patterns in the LAD were more variable and included long and short and both multi-focal and continuous (Figure). RCA CTOs were longer vs LAD/LCX; 19.2±14.5mm vs 11.7±8.2 mm, p<0.01 Conclusions: The IVUS pattern of plaque distribution within a CTO may depend on the presence of a sidebranch within the CTO length. Because the RCA anatomy is characterized by a paucity of sidebranches, a CTO in a may be longer and multi-focal in the RCA compared to the LAD or LCX.
ACC-i2 with TCT DIFFERENT PATTERNS OF CHRONIC TOTAL OCCLUSIONS IN THE RIGHT AND LEFT CORONARY ARTERIES: AN INTRAVASCULAR ULTRASOUND STUDY i2 Poster Contributions McCormick Place South, Hall A Saturday, March 24, 2012, 9:30 a.m.-Noon
Session Title: Chronic Total Occlusions Abstract Category: 11. PCI - Chronic Total Occlusions Presentation Number: 2526-414 Authors: Tadayuki Yakushiji, Akiko Maehara, Araki Hiroshi, Shigeo Saito, Martin Leon, Gregg Stone, Jeffrey Moses, Gary Mintz, Masahiko Ochiai, Cardiovascular Research Foundation, New York, NY, USA, Showa University Northern Yokohama Hospital, Yokohama, Japan Background: The anatomic pattern and length of a chronic total occlusion (CTO) may not be accurately evaluable by angiography. Methods: We used intravascular ultrasound (IVUS) to evaluate 178 CTO lesions after guidewire penetration without long (>10mm) false lumen wiring or hematoma to assess patterns of plaque distribution. Patterns were either 1) multi-focal: ≥2 separate occlusions separated by nonoccluded segment or 2) continuous: no non-occluded segment. Results: CTO was located in the RCA in 41%, LAD in 39%, and LCX in 20%. A sidebranch <5mm from the CTO end was observed in 82.1% of proximal and 62.8% of distal sites with only 25% of CTOs having a sidebranch originating within the CTO. IVUS showed a multi-focal pattern in 22 (12.4%) lesions that was more prevalent in the RCA (68%) vs the LAD (27%) and LCX (5%). A multi-focal pattern was more often associated with longer CTO length >20mm than shorter CTO length ≤20mm (64% vs 9%, p<0.001) and a sidebranch originating inside of the CTO (77% vs 18%, p<0.001). In general, RCA CTOs appeared long and multi-focal while the patterns in the LAD were more variable and included long and short and both multi-focal and continuous (Figure). RCA CTOs were longer vs LAD/LCX; 19.2±14.5mm vs 11.7±8.2 mm, p<0.01 Conclusions: The IVUS pattern of plaque distribution within a CTO may depend on the presence of a sidebranch within the CTO length. Because the RCA anatomy is characterized by a paucity of sidebranches, a CTO in a may be longer and multi-focal in the RCA compared to the LAD or LCX.