Using Intravenous Ultrasound to Guide Left Main Revascularization: What's the Cutoff?

In a prospective, multicenter case series, revascularization was safely deferred in uncomplicated LMCA lesions with an MLA of 6 mm² or more.

For left main coronary artery (LMCA) lesions, the need for revascularization might be better determined by minimum lumen area (MLA) as assessed by intravascular ultrasound (IVUS) rather than by stenosis percentage as assessed by coronary angiography. However, no criterion for an MLA threshold has yet been validated. In this prospective, multicenter, Spanish study supported by manufacturers of IVUS equipment, 354 patients with intermediate (25%–60% angiographic stenosis) LMCA lesions without ulceration, dissection, or thrombus underwent quantitative IVUS assessment. Per protocol, revascularization was recommended for lesions with an MLA <6 mm².

Of 186 patients with an MLA of ≥6 mm², 96% did not undergo revascularization. Of 168 patients with …

Reviewing Author

Howard C. Herrmann, MD

Disclosures

Consultant/Advisory BoardAffluent Medical; Artedrone; Caranx; Johnson & Johnson; Medtronic; Prolifagen; Wells Fargo

EquityMicrointerventional Devices, Inc.

RoyaltiesUniversity of Pennsylvania

Grant/Research SupportAbbott Vascular; Edwards Lifesciences; Johnson & Johnson; Medtronic

Editorial BoardsCatheterization and Cardiovascular Interventions; Journal of the American College of Cardiology; Circulation: Cardiovascular Interventions; JACC Cardiovascular Interventions; JACC Case Reports; JSCAI