Coronary angiography preprocedural lesion morphology

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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
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]

Overview

Preprocedural Lesion Morphology

Feature 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

References


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