Coronary angiography film quality

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Resident
Survival
Guide

Coronary Angiography

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General Principles

Overview
Historical Perspective
Contraindications
Appropriate Use Criteria for Revascularization
Complications
Technique
Film Quality

Anatomy & Projection Angles

Normal Anatomy

Coronary arteries
Dominance
Right System
Left System
Left Main
Left Anterior Descending
Circumflex
Median Ramus

Anatomic Variants

Separate Ostia
Anomalous Origins
Case Example
Fistula

Projection Angles

Standard Views
Left Coronary Artery
Right Coronary Artery

Epicardial Flow & Myocardial Perfusion

Epicardial Flow

TIMI Frame Count
TIMI Flow Grade
TIMI Grade 0 Flow
TIMI Grade 1 Flow
TIMI Grade 2 Flow
TIMI Grade 3 Flow
TIMI Grade 4 Flow
Pulsatile Flow
Deceleration

Myocardial Perfusion

TIMI Myocardial Perfusion Grade
TMP Grade 0
TMP Grade 0.5
TMP Grade 1
TMP Grade 2
TMP Grade 3

Lesion Complexity

ACC/AHA Lesion-Specific Classification of the Primary Target Stenosis

Preprocedural Lesion Morphology

Eccentricity
Irregularity
Ulceration
Intimal Flap
Aneurysm
Sawtooth Pattern
Length
Ostial location
Angulation
Proximal tortuosity
Degenerated SVG
Calcification
Total occlusion
Coronary Artery Thrombus
TIMI Thrombus Grade
TIMI Thrombus Grade 0
TIMI Thrombus Grade 1
TIMI Thrombus Grade 2
TIMI Thrombus Grade 3
TIMI Thrombus Grade 4
TIMI Thrombus Grade 5
TIMI Thrombus Grade 6

Lesion Morphology

Quantitative Coronary Angiography
Definitions of Preprocedural Lesion Morphology
Irregular Lesion
Disease Extent
Arterial Foreshortening
Infarct Related Artery
Restenosis
Degenerated SVG
Collaterals
Aneurysm
Bifurcation
Trifurcation
Ulceration

Left ventriculography

Technique
Quantification of LV Function
Quantification of Mitral Regurgitation

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vanessa Cherniauskas, M.D. [2]

Cine Film Quality of Coronary Angiography

Uninterpretable

The primary endpoint cannot be analyzed secondary to exceedingly poor film exposure or quality (e.g., no images on the film, insufficient contrast injection).

Poor

The primary endpoint can be analyzed with some degree of uncertainty secondary to under- or over-exposure, poor panning, poor engagement, insufficient contrast injection, injection prior to cine-filming, inadequate cine-filming duration, excess collimation, partial obscuration by the diaphragm, and/or omission of images showing major coronary arteries (left or right coronary system).

Average

The primary endpoint can be analyzed. Some images show under- or over-exposure, poor panning, poor engagement, insufficient contrast injection, injection prior to cine-filming, inadequate cine-filming duration, excess collimation, and/or partial obscuration by the diaphragm.

Good

The primary endpoint can be analyzed. Most images show proper exposure, proper panning, proper engagement, sufficient contrast injection, injection after cine-filming, adequate cine-filming duration, minimal collimation, and minimal obscuration by the diaphragm.

Excellent

The primary endpoint can be analyzed. All images show proper exposure, proper panning, proper engagement, sufficient contrast injection, injection after cine-filming, adequate cine-filming duration, minimal collimation, and minimal obscuration by the diaphragm. The culprit lesion is centered in the film during some portion of the cine run to minimize pincushion distortion for quantitative analysis. The culprit lesion is well laid out with no overlap of branches and orthogonal views are obtained to show the culprit lesion in its tightest dimension.

References


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