Irregular lesion

Coronary Angiography
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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.

Definition

A stenosis is classified as having irregular contour if the vascular margin is rough or has a "sawtooth" appearance.

Pathophysiology

The pathophysiology of lesion irregularity is represented by pre-existing intimal disruption and/or increased turbulence and shear stresses, which lead to platelet activation causing a large transcardiac gradient of serotonin (5-hydroxy-tryptamine). The resulting endothelial damage and lesion instability are associated with an increased risk of thrombotic occlusion and distal embolization.

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.
• 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.
• The lesion irregularity is the second most important risk factor of diameter stenosis as a predictor of future infarction.

Treatment

A continued anticoagulation is already known as responsible for restabilize the coronary plaque after thrombolysis and so substantially reduce the risk of reinfarction. Due to these findings the anticoagulants may be used in patients in whom particularly irregular lesions are demonstrated by coronary angiography.

References

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