Coronary artery ulceration

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: Rim Halaby, M.D. [2]

Overview

An ulcerated lesion is defined as a cavity in the vessel wall with disruption of the intima and flow observed within the plaque cavity. Coronary artery ulceration is assessed visually using a well defined grading system. Grade 0 corresponds to no angiographic evidence of ulceration, grade 1 ulceration is present when the lesion contains a neck with contrast material dissecting under the plaque either proximally or distally, and grade 2 ulceration is present when there is distinct extravascular extravasation of contrast material with the appearance of a mushroom.

Examples

Grade 0

Grade 0: No angiographic evidence of ulceration

Shown below are an animated image and a static image depicting a normal RCA with no evidence of ulceration.

Grade 1

Grade 1: The lesion contains a neck with contrast material dissecting under the plaque either proximally or distally.

Grade 2

Grade 2: Distinct extravascular extravasation of contrast material with the appearance of a mushroom

Shown below are an animated image and a static image depicting grade 2 ulcerated lesion. Encircled in yellow in the image on the right is the ulcerated lesion which has a "mushroom" appearance.

References

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