LAUSR

In their article on the angiographic and intravascular ultrasound (IVUS) imaging characteristics of mismatch coronary lesions (MCLs), Phan et al emphasize how common MCLs are and how these lesions offer many challenging characteristics for the interventionalist performing a percutaneous coronary intervention (PCI). The definition of MCL is a coronary artery lesion that has a significant difference in plaque burden between the distal and proximal segments. The authors found, by coronary angiography (CAG), a 24.1% incidence of mismatch lesions (411/1706 lesions) and reported that the mismatch lesions were longer than non-mismatch lesions (22.1 + 6.6 mm vs 18.7 + 6.4 mm, respectively; P < .001) and that they also had a smaller minimum lumen diameter by CAG (0.66 + 0.44 vs 0.98 + 0.45, respectively; P < .001). With IVUS, the mismatch group was reported to have a larger lumen diameter (3.65 + 0.52 mm vs 3.22 + 0.53 mm, respectively; P < .001), but with a lower plaque burden (41.4% + 9.4% vs 46.1% + 9.9%, respectively; P < .001), at the proximal reference segment of the lesion, whereas at the distal reference segment, there was a smaller lumen diameter (2.43 + 0.49 mm vs 2.99 + 0.59 mm, respectively; P < .001). In turn, by IVUS, there was a larger plaque burden at the distal segment (43.3% + 10.4% vs 41.6% + 10.3%, P 1⁄4 .004). Phan et al showed by multivariate analysis that mismatch lesions are more likely associated with a severe stenosis, a bifurcation lesion, a chronic total occlusion, and a diffuse lesion. Therefore, the major significance of MCLs is the increased potential for PCI complications, thus identifying a need for additional study to assess optimal PCI techniques and approaches.