Coronary angiography preprocedural lesion morphology

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]

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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