Assessing intermediate left main coronary lesions using intravascular ultrasound

Koichi Sano, Gary S. Mintz, Stéphane G. Carlier, Jose de Ribamar Costa, Jie Qian, Eduardo Missel, Shoujie Shan, Theresa Franklin-Bond, Paul Boland, Giora Weisz, Issam Moussa, George D. Dangas, Roxana Mehran, Alexandra J. Lansky, Edward M. Kreps, Michael B. Collins, Gregg W. Stone, Martin B. Leon, Jeffrey W. Moses

Research output: Contribution to journalArticlepeer-review


Background: Angiographic assessment of a left main coronary artery stenosis (LMCS) is often difficult and unreliable. We aimed to evaluate the severity of ambiguous LMCSs by intravascular ultrasound (IVUS) and to clarify how frequently significant stenosis occurs in the "real world". Methods: We retrospectively found 115 consecutive patients in our clinical IVUS database with a de novo, angiographically ambiguous, intermediate LMCS who underwent IVUS evaluation. Quantitative coronary angiography (QCA) and IVUS analyses were performed. We define a significant LMCS as a diameter stenosis >50% by QCA and a minimal lumen area <6.0mm2 by IVUS. Results: Ostial, mid, and distal LMCSs were seen in 44 (38.3%), 6 (5.2%), and 65 (56.5%) lesions. Overall, IVUS minimal lumen area and plaque burden measured 6.8 ± 2.6 mm2 and 63% ± 14%. A significant LMCS was seen in 51 (44.3%) lesions by IVUS but in only 15 (13.0%) lesions by QCA. In particular, only 36.4% of ostial lesions had a significant IVUS stenosis, and minimal lumen diameter by QCA was less well correlated with IVUS in ostial lesions than in other lesion locations. Conclusions: This real-world IVUS analysis showed that less than half of intermediate LMCSs had significant stenoses by IVUS assessment, especially for lesions located at the left main ostium. Such patients deserve IVUS assessment or physiologic assessment before blindly proceeding to revascularization.

Original languageEnglish (US)
Pages (from-to)983-988
Number of pages6
JournalAmerican Heart Journal
Issue number5
StatePublished - Nov 2007
Externally publishedYes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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