Coronary angiography ACC-AHA characteristics of type A, B, and C coronary lesions
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
The American College of Cardiology/American Heart Association (ACC/AHA) Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures developed a classification scheme to characterize the complexity of coronary stenoses and the probability of success of a percutaneous intervention. This system was developed in 1988 prior to the widespread deployment of coronary stents. [1]
Type A Lesions (High Success [> 85%]; Low Risk)
- Discrete (< 10 mm)
- Little or no calcium
- Concentric
- Less than totally occlusive
- Readily accessible
- Not ostial in location
- Nonangulated segment (< 45 degrees)
- No major side branch involvement
- Smooth contour
- Absence of thrombus
Type B Lesions (Moderate Success [60%–85%]; Moderate Risk)
- Tubular (10–20 mm length)
- Moderate to heavy calcification
- Eccentric
- Total occlusions < 3 months old
- Moderate tortuosity of proximal segment
- Ostial in location
- Moderately angulated (45-90 degrees)
- Bifurcation lesion requiring double guidewire
- Irregular contour
- Some thrombus present
Type C Lesions (Low Success [< 60%]; High Risk)
- Diffuse (> 20 mm length)
- Total occlusion > 3 months old and/or bridging collaterals
- Excessive tortuosity of proximal segment
- Inability to protect major side branches
- Extremely angulated segment (> 90 degrees)
- Degenerated saphenous vein grafts with friable lesions
Pathophysiology
Even in the modern era of stenting, the PERFUSE study group has shown that increasing lesion complexity is associated with impairments in both epicardial and myocardial perfusion.[2]
Natural History, Complications and Prognosis
Increased lesion complexity is associated with a higher risk of cardiogenic shock and cardiovascular death. [2][3]
References
- ↑ 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.
- ↑ 2.0 2.1 Gibson CM, Bigelow B, James D, Tepper MR, Murphy SA, Kirtane AJ; et al. (2004). "Association of lesion complexity following fibrinolytic administration with mortality in ST-elevation myocardial infarction". Am J Cardiol. 94 (1): 108–11. doi:10.1016/j.amjcard.2004.03.038. PMID 15219518.
- ↑ 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.