Intravascular ultrasound assessment of the spatial distribution of ruptured coronary plaques in the left anterior descending coronary artery

Background Plaque rupture is a substrate for thrombosis, occlusion, and myocardial infarction. The left anterior descending coronary artery (LAD) subtends the largest amount of myocardium; therefore, the location of LAD plaque rupture is of particular importance in detecting vulnerable plaques. The aim of our study was to assess the location of ruptured atherosclerotic plaques in the LAD. Methods Using intravascular ultrasound, we detected 160 ruptured LAD plaques. Of these, accurate intravascular ultrasound distance measurements (with consistent automatic transducer pullback [0.5 mm/s] to the LAD ostium) could be determined in 112 ruptured plaques. Results There were 104 patients (91 men, age 63.8 ± 11.7 years). The total length of the LAD that was imaged measured 48.8 ± 24.8 mm. The distance from the LAD origin to the maximal plaque cavity was 16.2 ± 10.3 mm; the maximal plaque cavity was localized to the first 20 mm of the LAD in 71% and the first 30 mm in 88%. Only 2 ruptured plaques were found beyond 40 mm from the LAD ostium. Conclusions The majority of LAD ruptured plaques are located within the proximal 30 mm of the artery. This area of the LAD should be targeted for vulnerable (rupture-prone) plaque detection and prevention.