|
|
| (9 intermediate revisions by 2 users not shown) |
| Line 1: |
Line 1: |
| __NOTOC__
| | #REDIRECT [[Coronary artery irregularity]] |
| {{Coronary angiography2}}
| |
| {{CMG}}
| |
| | |
| ==Overview==
| |
| The appearence of irregular lesions with intraluminal filling defects and contrast staining is detected by [[coronary angiography]] and may indicate a fissured [[Atherosclerosis|atherosclerotic plaque]] with adherent [[thrombus]].<ref name="Davies-1991">{{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 = Irregular coronary lesion morphology after thrombolysis predicts early clinical instability. | journal = J Am Coll Cardiol | volume = 18 | issue = 3 | pages = 669-74 | month = Sep | year = 1991 | doi = | PMID = 1869729 }}</ref>
| |
| | |
| ==Definition==
| |
| A stenosis is classified as having '''irregular contour''' if the vascular margin is rough or has a "sawtooth" appearance.<ref name="Ellis-1990">{{Cite journal | last1 = Ellis | first1 = SG. | last2 = Vandormael | first2 = MG. | last3 = Cowley | first3 = MJ. | last4 = DiSciascio | first4 = G. | last5 = Deligonul | first5 = U. | last6 = Topol | first6 = EJ. | last7 = Bulle | first7 = TM. | title = Coronary morphologic and clinical determinants of procedural outcome with angioplasty for multivessel coronary disease. Implications for patient selection. Multivessel Angioplasty Prognosis Study Group. | journal = Circulation | volume = 82 | issue = 4 | pages = 1193-202 | month = Oct | year = 1990 | doi = | PMID = 2401060 }}</ref>
| |
| | |
| ==Pathophysiology==
| |
| The pathophysiology of lesion irregularity is represented by pre-existing intimal disruption and/or increased [[turbulence]] and [[shear stress]]es, which lead to [[platelet activation]] causing a large transcardiac gradient of serotonin (5-hydroxy-tryptamine).<ref name="van den Berg-1989">{{Cite journal | last1 = van den Berg | first1 = EK. | last2 = Schmitz | first2 = JM. | last3 = Benedict | first3 = CR. | last4 = Malloy | first4 = CR. | last5 = Willerson | first5 = JT. | last6 = Dehmer | first6 = GJ. | title = Transcardiac serotonin concentration is increased in selected patients with limiting angina and complex coronary lesion morphology. | journal = Circulation | volume = 79 | issue = 1 | pages = 116-24 | month = Jan | year = 1989 | doi = | PMID = 2910538 }}</ref The resulting [[endothelium|endothelial]] damage and lesion instability are associated with an increased risk of thrombotic occlusion and [[distal embolization]].<ref name="Falk-1985">{{Cite journal | last1 = Falk | first1 = E. | title = Unstable angina with fatal outcome: dynamic coronary thrombosis leading to infarction and/or sudden death. Autopsy evidence of recurrent mural thrombosis with peripheral embolization culminating in total vascular occlusion. | journal = Circulation | volume = 71 | issue = 4 | pages = 699-708 | month = Apr | year = 1985 | doi = | PMID = 3971539 }}</ref><ref name="Davies-1986">{{Cite journal | last1 = Davies | first1 = MJ. | last2 = Thomas | first2 = AC. | last3 = Knapman | first3 = PA. | last4 = Hangartner | first4 = JR. | title = Intramyocardial platelet aggregation in patients with unstable angina suffering sudden ischemic cardiac death. | journal = Circulation | volume = 73 | issue = 3 | pages = 418-27 | month = Mar | year = 1986 | doi = | PMID = 3948352 }}</ref>
| |
| | |
| ==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.<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==
| |
| | |
| ==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.<ref name="-1988">{{Cite journal | title = Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. | journal = Lancet | volume = 2 | issue = 8607 | pages = 349-60 | month = Aug | year = 1988 | doi = | PMID = 2899772 }}</ref>
| |
| | |
| ==References==
| |
| {{Reflist|2}}
| |
| | |
| [[Category:Angiopedia]]
| |
| [[Category:Cardiology]]
| |
| | |
| {{WikiDoc Help Menu}}
| |
| {{WikiDoc Sources}}
| |