PCI: classification of the lesion

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Risk Stratification and Benefits of PCI

Preparation of the Patient for PCI

Equipment Used During PCI

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Recommendations for Perioperative Management–Timing of Elective Noncardiac Surgery in Patients Treated With PCI and DAPT

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PCI Complications

Factors Associated with Complications
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PCI in Specific Patients

Cardiogenic Shock
Left Main Coronary Artery Disease
Refractory Ventricular Arrhythmia
Severely Depressed Ventricular Function
Sole Remaining Conduit
Unprotected Left Main Patient
Adjuncts for High Risk PCI

PCI in Specific Lesion Types

Classification of the Lesion
The Calcified Lesion
The Ostial Lesion
The Angulated or Tortuous Lesion
The Bifurcation Lesion
The Long Lesion
The Bridge Lesion
Vasospasm
The Chronic Total Occlusion
The Left Internal Mammary Artery
Multivessel Disease
Distal Anastomotic Lesions
Left Main Intervention
The Thrombotic Lesion

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

According to the Abrupt Vessel Closure - AHA Task Force Definition, as modified by Ellis et al., coronary lesion complexity is typed as A, B1, B2, and C.[1][2][3]

Classification of the Lesion

Type A

<10mm, discrete, concentric readily accessible, <45 degree angle smooth contour, little or no calcification, less than totally occluded, not ostial, no major side branch involvement, absence of thrombus.

Type B1

One of the following characteristics: 10-20mm, eccentric, moderate tortuosity of proximal segment, irregular contour, presence of any thrombus grade, moderate or heavy calcification, total occlusion <3 months old, ostial lesion or bifurcation lesion requiring two guidewires.

Type B2

Two or more of the following characteristics: 10-20mm, eccentric, moderate tortuosity or proximal segment, irregular contour, presence of any thrombus grade, moderate or heavy calcification, total occlusion <3 months old, ostial lesion or bifurcation lesion requiring two guidewires.

Type C

>20 mm diffuse, excessive tortuosity of proximal segment, total occlusion >3 months old and/or bridging collaterals inability to protect major side branches, degenerated vein graft with friable lesions.

References

  1. Ryan TJ, Faxon DP, Gunnar RM, Kennedy JW, King SB III, Loop FD,Peterson KL, Reeves TJ, Williams DO, Winters WL Jr, et al. Guidelines for percutaneous transluminal coronary angioplasty. A report of the American College of Cardiology/American Heart Association Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures (Subcommittee on Percutaneous Transluminal Coronary Angioplasty). Circulation 1988;78:486–502.
  2. Ellis, SG.; Roubin, GS.; King, SB.; Douglas, JS.; Weintraub, WS.; Thomas, RG.; Cox, WR. (1988). "Angiographic and clinical predictors of acute closure after native vessel coronary angioplasty". Circulation. 77 (2): 372–9. PMID 2962787. Unknown parameter |month= ignored (help)
  3. Ellis SG, Vandormael MG, Cowley MJ, DiSciascio G, Deligonul U, Topol EJ, Bulle TM. Coronary morphologic and clinical determinants of procedural outcome with angioplasty for multivessel coronary disease. Implications for patient selection. Multivessel Angioplasty Prognosis Study Group. Circulation 1990;82:1193–1202.



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