Coronary angiography

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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]

Synonyms and keywords: coronary arteriography, cardiac arteriography, cardiac angiogram, coronary angio, coronary artery angio, coronary cath, cardiac cath

General Principles

• Overview
• Historical perspective
• Contraindications
• Appropriate Use Criteria for Revascularization
• Complications
• Technique
• Film Quality

Coronary Anatomy and Projection Angles

Normal Coronary Anatomy

• Coronary arteries
• Left coronary artery | Left main coronary artery | Left anterior descending artery | Left circumflex artery | Ramus intermedius
• Right coronary artery
• Coronary artery dominance

Coronary Anatomic Variants

• Separate ostia
• Anomalous origins of the coronary arteries
• Coronary artery fistula

Projection Angles

• Standard angiographic views
• Left coronary artery
• Right coronary artery

Assessment of Perfusion

How to Assess Epicardial Coronary Blood Flow

• TIMI flow grade (TFG): TIMI flow grade 0 | TIMI flow grade 1 | TIMI flow grade 2 | TIMI flow grade 3
• TIMI frame count (TFC)
• Pulsatile flow
• Deceleration

How to Assess Myocardial Perfusion

• TIMI myocardial perfusion grade (TMPG): TIMI myocardial perfusion grade 0 | TIMI myocardial perfusion grade 0.5 | TIMI myocardial perfusion grade 1 | TIMI myocardial perfusion grade 2 | TIMI myocardial perfusion grade 3

Assessment of Lesion Morphology

Lesion Complexity

• ACC-AHA characteristics of type A, B, and C coronary lesions
• SCAI Lesion Classification System

Thrombus Grades

• 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 angiography
• Definitions of Preprocedural Lesion Morphology
• Irregular lesion
• Disease extent
• Arterial foreshortening
• Infarct related artery (Culprit lesion)
• Restenosis
• Degenerated saphenous vein graft
• Collaterals
• Coronary artery ulceration
• Coronary artery aneurysm
• Coronary artery bifurcation
• Coronary artery trifurcation

Left Ventriculography

• Technique
• Quantification of LV Function
• Quantification of Mitral Regurgitation
• Left Ventricular Ejection Fraction Assessment by Visual Estimation

Vein and Arterial Bypass Graft

Left Internal Mammary Artery

Performing Diagnostic Catheterization

Risks stratification and benefits of PCI | Conscious Sedation | Preparation of the Patient for Diagnostic Catheterization | Technical Aspects of the Cardiac Catheterization Laboratory | Obtaining Venous and Arterial Access | Equipment Used in Diagnostic Cardiac Catheterizaiton | Hemodynamic Assessment in the Cardiac Catheterization Laboratory | Radiation Safety

Therapeutic Catheterization

Therapeutic procedures | Advances in catheter based physical treatments

PCI in Specific Lesion Types

Classification of the Lesion | The Calcified Lesion | The Ostial Lesion | The Angulated or Tortuous Lesion | The Bifurcation Lesion | The Long Lesion | The Bridge Lesion | Vasospasm | The Chronic Total Occlusion | Multivessel Disease | Distal Anastomotic Lesions | Left Main Intervention | The Thrombotic Lesion

PCI Complications

Vessel Perforation | Dissection | Distal Embolization | No-reflow | Abrupt Closure | Restenosis | Late Acquired Stent Malapposition | Loss of Side Branch | Multiple Complications | Coronary stent thrombosis | Slow flow | Pulsatile flow | Deceleration | Ectasia | Intimal flap | Staining | Coronary air embolism

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