(Circulation. 1996;93:924-931.)
© 1996 American Heart Association, Inc.
Articles |
Limitations of Angiography in the Assessment of Plaque Distribution in Coronary Artery Disease
A Systematic Study of Target Lesion Eccentricity in 1446 Lesions
From the Intravascular Ultrasound Imaging and Cardiac Catheterization Laboratories of the Washington (DC) Hospital Center.
Correspondence to Martin B. Leon, MD, Director of Research, Washington Cardiology Center, 110 Irving St NW (4B-1), Washington, DC 20010.
Background Plaque distribution (eccentricity) may be a determinant of the success of transcatheter therapy, and certain devices may be better suited to treating severely eccentric lesions than others. However, no study has compared methods for assessing plaque distribution or systematically studied the validity of the angiographic assessment of plaque distribution.
Methods and Results We studied 1446 native vessel target
lesions in 1349 patients by intravascular ultrasound and
coronary angiography. Angiographic and intravascular ultrasound
criteria for lesion eccentricity were compared. Angiography
showed that 795 of 1446 (55.0%) of target lesions were
eccentric. When intravascular ultrasound was used, only 219 lesions
(15.1%) had an arc of normal arterial wall within the
lesion (equivalent to the pathological definition of lesion
eccentricity). When an eccentricity index of 
3.0 was used,
intravascular ultrasound classified 659 lesions (45.6%) as eccentric.
The concordance rates of classification were only 47.7% (versus
lesions containing an arc of normal arterial wall) and
53.8% (versus lesions with an ultrasound eccentricity index of 3.0).
More eccentric lesions had larger lumen cross-sectional areas,
smaller plaque plus media and external elastic membrane
cross-sectional areas, and smaller arcs of calcium, suggesting that
they may represent less advanced atherosclerotic disease.
Conclusions There was significant discordance between angiography and ultrasound in assessing plaque distribution. Angiography appeared to detect lesion eccentricity more often than intravascular ultrasound. Furthermore, markedly eccentric lesions, in which there is an arc of normal vessel wall, were uncommon.
Key Words: angiography • ultrasonics • coronary disease
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