Multislice computerized tomography coronary angiography can be a comparable tool to intravascular ultrasound in evaluating "true" coronary artery bifurcations

Anja Radunović; Radosav Vidaković; Stefan Timčić; Natalija Odanović; Milica Stefanović; Mirko Lipovac; Kosta Krupniković; Aleksandar Mandić; Dejan Kojić; Milosav Tomović; Ivan Ilić

doi:10.3389/fcvm.2023.1292517

Multislice computerized tomography coronary angiography can be a comparable tool to intravascular ultrasound in evaluating "true" coronary artery bifurcations

Front Cardiovasc Med. 2023 Nov 6:10:1292517. doi: 10.3389/fcvm.2023.1292517. eCollection 2023.

Authors

Affiliations

¹ Department of Cardiology, Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia.
² Department of Cardiology, Clinical Hospital Center Zemun, Belgrade, Serbia.
³ Faculty of Medicine, University of Belgrade, Belgrade, Serbia.

Abstract

Aim: Coronary bifurcation atherosclerosis depends on its angles, flow, and extensive branching. We investigate the ability of CT coronary angiography (CTCA) to determine atherosclerotic plaque characteristics of "true" bifurcation compared with intravascular ultrasound (IVUS) and the influence on side branch (SB) fate after percutaneous coronary intervention (PCI).

Methods and results: The study included 70 patients with 72 "true" bifurcations. Most of the bifurcations were in the left anterior descending-diagonal (Dg) territory [50 out of 72 (69.4%)]. Longitudinal plaque evaluation at the polygon of confluence [carina and 5 mm proximal and distal in the main branch (MB)] showed that carina side MB and SB plaque had occurred with the lowest incidence with fibro-lipid structure (115 ± 63 HU and 89 ± 73 HU, p < 0.001 for all). Bland-Altman analysis showed a discrepancy in measuring mainly the lumen area between CTCA and IVUS in proximal MB [lumen 5.10, 95% CI (95% confidence interval, 4.53-5.68) mm², p < 0.001; vessel -1.42, 95% CI (-2.63 to -0.21) mm², p = 0.023], carina MB [lumen 3.74, 95% CI (3.37-4.10) mm², p < 0.001; vessel -0.48, 95% CI (-1.45 to 0.48) mm², p = 0.322], and distal MB [lumen 4.72, 95% CI (4.27-5.18) mm², p < 0.001; vessel 0.62, 95% CI (-0.53 to 1.77) mm², p = 0.283]. A significant correlation existed between average plaque density on CTCA with a percentage of calcified plaque on IVUS tissue characterization (proximal r = 0.307/p = 0.024, carina 0.469/0.008, distal 0.339/0.024, minimal lumen diameter 0.318/0.020). Circumferential plaque in the proximal MB segment remained an independent predictor of SB compromise [OR 3.962 (95% CI 1.170-13.418)].

Conclusion: Detection and characterization of atherosclerotic plaque by CTCA in non-left main "true" coronary bifurcations can provide useful information about bifurcation anatomy and plaque distribution that can predict outcomes after provisional stenting, thus guiding the interventional strategy to bifurcation PCI.

Keywords: CT coronary angiography; IVUS; PCI; atherosclerosis plaque; coronary artery bifurcation.

Grants and funding

The authors declare that no financial support was received for the research, authorship, and/or publication of this article.