Coronary artery ulceration

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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
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: Rim Halaby, M.D. [2]

Overview

An ulcerated lesion is defined as a cavity in the vessel wall with disruption of the intima and flow observed within the plaque cavity. Coronary artery ulceration is assessed visually using a well defined grading system. Grade 0 corresponds to no angiographic evidence of ulceration, grade 1 ulceration is present when the lesion contains a neck with contrast material dissecting under the plaque either proximally or distally, and grade 2 ulceration is present when there is distinct extravascular extravasation of contrast material with the appearance of a mushroom.

Examples

Grade 0

Grade 0: No angiographic evidence of ulceration

Shown below are an animated image and a static image depicting a normal RCA with no evidence of ulceration.

Grade 0 ulceration in the RCA Grade 0 ulceration in the RCA

Grade 1

Grade 1: The lesion contains a neck with contrast material dissecting under the plaque either proximally or distally.

Grade 2

Grade 2: Distinct extravascular extravasation of contrast material with the appearance of a mushroom

Shown below are an animated image and a static image depicting grade 2 ulcerated lesion. Encircled in yellow in the image on the right is the ulcerated lesion which has a "mushroom" appearance.

Grade 2 ulcerated lesion with a "mushroom"appearance" Grade 2 ulcerated lesion with a "mushroom"appearance"

References


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