Beyond the lumen border: on the use of intravascular ultrasound in the left main coronary artery

Intravascular ultrasound (IVUS) imaging permits the assessment of coronary atherosclerosis in vivo1, and for nearly two decades greyscale IVUS has been used to guide percutaneous coronary interventions (PCI), especially in challenging lesion subsets such as major bifurcations2. More recently, spectral analysis of radiofrequency IVUS data (RF-IVUS) has been used to obtain further quantitative information on coronary plaque components (e.g., necrotic core), which has permitted characterisation of certain plaque phenotypes such as the “vulnerable” thin-cap fibroatheroma (TCFA)1,3,4. The left main (LM) stem has extensively been studied with IVUS1,5-16.