Irregular lesion: Difference between revisions
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==Clinical Significance== | ==Clinical Significance== | ||
* The degree of irregularity is correlated with the risk of clinical instability in the next 10 days once the unstable features partially resolve over 5 to 10 days.<ref name="Davies-1990">{{Cite journal | last1 = Davies | first1 = SW. | last2 = Marchant | first2 = B. | last3 = Lyons | first3 = JP. | last4 = Timmis | first4 = AD. | last5 = Rothman | first5 = MT. | last6 = Layton | first6 = CA. | last7 = Balcon | first7 = R. | title = Coronary lesion morphology in acute myocardial infarction: demonstration of early remodeling after streptokinase treatment. | journal = J Am Coll Cardiol | volume = 16 | issue = 5 | pages = 1079-86 | month = Nov | year = 1990 | doi = | PMID = 2229751 }}</ref> | |||
* Greater irregularity of lesions are more likely to appear in the infarct-related artery than in lesions in the other coronary arteries of patients with acute infarction. and they are also related to the appearence of unstable angina.<ref name="Wilson-1986">{{Cite journal | last1 = Wilson | first1 = RF. | last2 = Holida | first2 = MD. | last3 = White | first3 = CW. | title = Quantitative angiographic morphology of coronary stenoses leading to myocardial infarction or unstable angina. | journal = Circulation | volume = 73 | issue = 2 | pages = 286-93 | month = Feb | year = 1986 | doi = | PMID = 3943163 }}</ref> | |||
* The lesion irregularity is the second most important risk factor of diameter stenosis as a predictor of future infarction.<ref name="Ellis-1989">{{Cite journal | last1 = Ellis | first1 = S. | last2 = Alderman | first2 = EL. | last3 = Cain | first3 = K. | last4 = Wright | first4 = A. | last5 = Bourassa | first5 = M. | last6 = Fisher | first6 = L. | title = Morphology of left anterior descending coronary territory lesions as a predictor of anterior myocardial infarction: a CASS Registry Study. | journal = J Am Coll Cardiol | volume = 13 | issue = 7 | pages = 1481-91 | month = Jun | year = 1989 | doi = | PMID = 2656822 }}</ref> | |||
==Example== | ==Example== | ||
Revision as of 19:35, 21 November 2013
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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]
Overview
The appearence of irregular lesions with intraluminal filling defects and contrast staining is detected by coronary angiography and may indicate a fissured atherosclerotic plaque with adherent thrombus.[1]
Definition
A stenosis is classified as having irregular contour if the vascular margin is rough or has a "sawtooth" appearance.[2]
Pathophysiology
Grading of Lesion Irregularity
- Grade 0: Smooth – no irregularity.
- Grade 1: Mildly Irregular – lesion has an indistinct lumen edge.
- Grade 2: Sawtoothed/Grossly Irregular – lesion has defined jagged or “sawtoothed” lumen edges.
Clinical Significance
- The degree of irregularity is correlated with the risk of clinical instability in the next 10 days once the unstable features partially resolve over 5 to 10 days.[3]
- Greater irregularity of lesions are more likely to appear in the infarct-related artery than in lesions in the other coronary arteries of patients with acute infarction. and they are also related to the appearence of unstable angina.[4]
- The lesion irregularity is the second most important risk factor of diameter stenosis as a predictor of future infarction.[5]
Example
References
- ↑ Davies, SW.; Marchant, B.; Lyons, JP.; Timmis, AD.; Rothman, MT.; Layton, CA.; Balcon, R. (1991). "Irregular coronary lesion morphology after thrombolysis predicts early clinical instability". J Am Coll Cardiol. 18 (3): 669–74. PMID 1869729. Unknown parameter
|month=ignored (help) - ↑ Ellis, SG.; Vandormael, MG.; Cowley, MJ.; DiSciascio, G.; Deligonul, U.; Topol, EJ.; Bulle, TM. (1990). "Coronary morphologic and clinical determinants of procedural outcome with angioplasty for multivessel coronary disease. Implications for patient selection. Multivessel Angioplasty Prognosis Study Group". Circulation. 82 (4): 1193–202. PMID 2401060. Unknown parameter
|month=ignored (help) - ↑ Davies, SW.; Marchant, B.; Lyons, JP.; Timmis, AD.; Rothman, MT.; Layton, CA.; Balcon, R. (1990). "Coronary lesion morphology in acute myocardial infarction: demonstration of early remodeling after streptokinase treatment". J Am Coll Cardiol. 16 (5): 1079–86. PMID 2229751. Unknown parameter
|month=ignored (help) - ↑ Wilson, RF.; Holida, MD.; White, CW. (1986). "Quantitative angiographic morphology of coronary stenoses leading to myocardial infarction or unstable angina". Circulation. 73 (2): 286–93. PMID 3943163. Unknown parameter
|month=ignored (help) - ↑ Ellis, S.; Alderman, EL.; Cain, K.; Wright, A.; Bourassa, M.; Fisher, L. (1989). "Morphology of left anterior descending coronary territory lesions as a predictor of anterior myocardial infarction: a CASS Registry Study". J Am Coll Cardiol. 13 (7): 1481–91. PMID 2656822. Unknown parameter
|month=ignored (help)