Coronary artery eccentricity

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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

Definition

Coronary lesions were morphologically classified as follows by a consensus of the same three angiographers on the basis of qualitative analysis of each lesion in at least two projections:[1]

Type Definition
Types of Stenoses
Concentric stenosis Symmetric narrowing of a coronary artery.
The borders of this lesion were smooth or only slightly irregular.
Eccentric stenosis
Asymmetric narrowing of a coronary artery.
Two subgroups of eccentric lesions were categorized:
Type I eccentric lesion: any asymmetric stenosis with smooth borders and a broad neck.
Type II eccentric lesion: an asymmetric stenosis usually in the form of a convex intraluminal obstruction with a narrow base or neck due to one or more overhanging edges or borders that were very irregular or scalloped.

Multiple irregularities Three or more serial and severe (≥70%) closely spaced obstructions in a coronary artery.
This classification also included coronary arteries with severe diffuse irregularities or arteries in which the segment of a coronary artery between two severe obstructions also exhibited significant diffuse luminal irregularities.

Pathophysiology

Clinical Significance

Example

References

  1. Ambrose, JA.; Winters, SL.; Stern, A.; Eng, A.; Teichholz, LE.; Gorlin, R.; Fuster, V. (1985). "Angiographic morphology and the pathogenesis of unstable angina pectoris". J Am Coll Cardiol. 5 (3): 609–16. PMID 3973257. Unknown parameter |month= ignored (help)


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