Coronary angiography preprocedural lesion morphology
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Coronary Angiography | |
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General Principles | |
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Anatomy & Projection Angles | |
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Normal Anatomy | |
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Anatomic Variants | |
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Projection Angles | |
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Epicardial Flow & Myocardial Perfusion | |
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Epicardial Flow | |
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Myocardial Perfusion | |
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Lesion Complexity | |
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ACC/AHA Lesion-Specific Classification of the Primary Target Stenosis | |
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Lesion Morphology | |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vanessa Cherniauskas, M.D. [2]
Overview
Preprocedural Lesion Morphology
{ border="1" cellpadding="4" cellspacing="0" style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;" | align="center" style="background:#f0f0f0;"|Feature | align="center" style="background:#f0f0f0;"|Definition |- | Eccentricity||Stenosis that is noted to have one of its luminal edges in the outer one-quarter of the apparently normal lumen |- | Irregularity ||Characterized by lesion ulceration, intimal flap, aneurysm, or “sawtooth” pattern |- | ____Ulceration || Lesion with a small crater consisting of a discrete luminal widening in the area of the stenosis is noted, provided that it does not extend beyond the normal arterial lumen |- | ____Intimal flap||A mobile, radiolucent extension of the vessel wall into the arterial lumen |- | ____Aneurysmal dilation||Segment of arterial dilation larger than the dimensions of the normal arterial segment |- | ____“Sawtooth pattern”||Multiple, sequential stenosis irregularities |- | Lesion length ||Measured “shoulder-to-shoulder” in an unforeshortened view |- | ____Discrete||Lesion length <10 mm |- | ____Tubular||Lesion length 10-20 mm |- | ____Diffuse||Lesion length ≥20 mm |- | Ostial location||Origin of the lesion within 3 mm of the vessel origin |- | Lesion angulation||Vessel angle formed by the centerline through the lumen proximal to the stenosis and extending beyond it and a second centerline in the straight portion of the artery distal to the stenosis |- | ____Moderate||Lesion angulation ≥45 degrees |- | ____Severe||Lesion angulation ≥90 degrees |- | Bifurcation stenosis||Present if a medium or large branch (>1.5 mm) originates within the stenosis and if the side branch is completely surrounded by stenotic portions of the lesion to be dilated |- | Lesion accessibility (proximal tortuosity) || |- | ____Moderate tortuosity ||Lesion is distal to two bends ≥75 degrees |- | ____Severe tortuosity||Lesion is distal to three bends ≥75 degrees |- | Degenerated SVG ||Graft characterized by luminal irregularities or ectasia comprising >50% of the graft length |- | Calcification||Readily apparent densities noted within the apparent vascular wall at the site of the stenosis |- | ____Moderate||Densities noted only with cardiac motion before contrast injection |- | ____Severe||Radiopacities noted without cardiac motion before contrast injection |- | Total occlusion ||TIMI 0 or 1 flow |- | Thrombus||Discrete, intraluminal filling defect is noted with defined borders and is largely separated from the adjacent wall; contrast staining may or may not be present |}