Coronary angiography: Difference between revisions

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{| class="infobox" style="float:right;"
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| [[File:Siren.gif|30px|link=Cardiac catheterization pre-procedure evaluation resident survival guide]]|| <br> || <br>
| [[Cardiac catheterization pre-procedure evaluation resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
|}
{{Coronary angiography2}}
{{CMG}}
{{CMG}}


{{SK}} coronary arteriography, cardiac arteriography, cardiac angiogram, coronary angio, coronary artery angio, coronary cath, cardiac cath
{{SK}} coronary arteriography, cardiac arteriography, cardiac angiogram, coronary angio, coronary artery angio, coronary cath, cardiac cath


{|width="50%" cellpadding="2" cellspacing="5" style="vertical-align:top; background:#f5fffa;"
==General Principles==
|-
! style="margin:0; background:#cedff2; font-size:120%; font-weight:bold; border:1px solid#a3b0bf; text-align:left; color:#000; padding:0.2em 0.4em; " colspan="2" | Section I: General Principles
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|style="color:#000; font-size:90%; vertical-align:top"|
==Introduction==  
* [[Coronary angiography overview|Overview]]
* [[Coronary angiography overview|Overview]]
* [[Coronary angiography historical perspective|Historical perspective]]
* [[Coronary angiography historical perspective|Historical perspective]]
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* [[Appropriate use criteria for revascularization|Appropriate Use Criteria for Revascularization]]
* [[Appropriate use criteria for revascularization|Appropriate Use Criteria for Revascularization]]
* [[Coronary angiography complications|Complications]]
* [[Coronary angiography complications|Complications]]
==Technique==
* [[Coronary angiography diagnostic procedures|Diagnostic procedures]]
* [[Coronary angiography technique|Technique]]
* [[Coronary angiography technique|Technique]]
* [[Coronary angiography film quality|Film Quality]]


==Angiographic Core Lab Definitions==
==Coronary Anatomy and Projection Angles==
* Definitions of commonly used terms
===Normal Coronary Anatomy===
* Angiographic film quality
|}
 
{|width="50%" cellpadding="2" cellspacing="5" style="vertical-align:top; background:#f5fffa;"
|-
! style="margin:0; background:#cedff2; font-size:120%; font-weight:bold; border:1px solid#a3b0bf; text-align:left; color:#000; padding:0.2em 0.4em; " colspan="2" | Section II: Coronary Anatomy and Projection Angles
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|style="color:#000; font-size:90%; vertical-align:top"|
==Normal Coronary Anatomy==
* [[Coronary arteries]]
* [[Coronary arteries]]
* [[Left coronary artery]] | [[Left main coronary artery]] | [[Left anterior descending artery]]  |  [[Left circumflex artery]] | [[Ramus intermedius]]
* [[Left coronary artery]] | [[Left main coronary artery]] | [[Left anterior descending artery]]  |  [[Left circumflex artery]] | [[Ramus intermedius]]
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* [[Coronary artery dominance]]
* [[Coronary artery dominance]]


==Coronary Anatomic Variants==
===Coronary Anatomic Variants===
* [[Separate ostia]]
* [[Separate ostia]]
* [[Anomalous origins of the coronary arteries]]
* [[Anomalous origins of the coronary arteries]]
* [[Coronary artery fistula]]
* [[Coronary artery fistula]]


==Projection Angles==
===Projection Angles===
* [[Coronary angiography essentials of optimal coronary angiographic projections|Essentials of optimal coronary angiographic projections]]
* [[Coronary angiography standard views|Standard angiographic views]]
* [[Coronary angiography standard views|Standard angiographic views]]
* [[Coronary angiography left coronary artery|Left coronary artery]]
* [[Coronary angiography left coronary artery|Left coronary artery]]
* [[Coronary angiography right coronary artery|Right coronary artery]]
* [[Coronary angiography right coronary artery|Right coronary artery]]
|}


{|width="50%" cellpadding="2" cellspacing="5" style="vertical-align:top; background:#f5fffa;"
|-
! style="margin:0; background:#cedff2; font-size:120%; font-weight:bold; border:1px solid#a3b0bf; text-align:left; color:#000; padding:0.2em 0.4em; " colspan="2" | Section III: Angiogram Analysis
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|style="color:#000; font-size:90%; vertical-align:top"|
==Assessment of Perfusion==
==Assessment of Perfusion==
===How to Assess Epicardial Coronary Blood Flow===
===How to Assess Epicardial Coronary Blood Flow===
* [[TIMI flow grade]]: [[TIMI flow grade 0]] | [[TIMI flow grade 1]] | [[TIMI flow grade 2]] | [[TIMI flow grade 3]]
* [[TIMI flow grade|TIMI flow grade (TFG)]]: [[TIMI flow grade 0]] | [[TIMI flow grade 1]] | [[TIMI flow grade 2]] | [[TIMI flow grade 3]]
* [[TIMI frame count (TFC)]]
* [[TIMI frame count (TFC)]]
* Pulsatile flow
* [[Pulsatile flow]]
* Deceleration
* [[Deceleration]]


===How to Assess Myocardial Perfusion===
===How to Assess Myocardial Perfusion===
*[[TIMI myocardial perfusion grade]]: [[TIMI myocardial perfusion grade 0]] | [[TIMI myocardial perfusion grade 1]] | [[TIMI myocardial perfusion grade 2]] | [[TIMI myocardial perfusion grade 3]]
*[[TIMI Myocardial Perfusion Grade|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==
==Assessment of Lesion Morphology==
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===Lesion Complexity===
===Lesion Complexity===
* [[Coronary angiography ACC-AHA characteristics of type A, B, and C coronary lesions|ACC-AHA characteristics of type A, B, and C coronary lesions]]
* [[Coronary angiography ACC-AHA characteristics of type A, B, and C coronary lesions|ACC-AHA characteristics of type A, B, and C coronary lesions]]
* [[Coronary angiography risk assessment using lesion morphologic criteria|Risk assessment using lesion morphologic criteria]]
* [[Coronary angiography SCAI lesion classification system|SCAI Lesion Classification System]]


===Thrombus Grade===
===Thrombus Grades===
* [[PERFUSE thrombus grade]]: [[PERFUSE thrombus grade 0]] | [[PERFUSE thrombus grade 1]] | [[PERFUSE thrombus grade 2]] | [[PERFUSE thrombus grade 3]] | [[PERFUSE thrombus grade 4]] | [[PERFUSE thrombus grade 5]] | [[PERFUSE thrombus grade 6]]
* [[PERFUSE thrombus grade|TIMI thrombus grade]]: [[PERFUSE thrombus grade 0|TIMI thrombus grade 0]] | [[PERFUSE thrombus grade 1|TIMI thrombus grade 1]] | [[PERFUSE thrombus grade 2|TIMI thrombus grade 2]] | [[PERFUSE thrombus grade 3|TIMI thrombus grade 3]] | [[PERFUSE thrombus grade 4|TIMI thrombus grade 4]] | [[PERFUSE thrombus grade 5|TIMI thrombus grade 5]] | [[PERFUSE thrombus grade 6|TIMI thrombus grade 6]]


===Lesion Morphology===
===Lesion Morphology===
* [[Coronary angiography quantitative angiography|Quantitative angiography]]: Minimal lumen diameter • Percent stenosis • Reference diameter • Lesion length • Residual stenosis • Average reference segment diameter • Plaque area • Plaque volume •
* [[Coronary angiography quantitative angiography|Quantitative angiography]]
* [[Quantitative coronary angiography#Definitions of Preprocedural Lesion Morphology|Definitions of Preprocedural Lesion Morphology]]
* [[Quantitative coronary angiography#Definitions of Preprocedural Lesion Morphology|Definitions of Preprocedural Lesion Morphology]]
* Irregular lesion
* Irregular lesion
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* [[Coronary artery bifurcation]]
* [[Coronary artery bifurcation]]
* [[Coronary artery trifurcation]]
* [[Coronary artery trifurcation]]
==[[Left ventriculography|Left Ventriculography]]==
* [[Left ventriculography#Technique|Technique]]
* [[Left ventriculography#Quantification of Left Ventricular Function|Quantification of LV Function]]
* [[Left ventriculography#Quantification of LMitral Regurgitation|Quantification of Mitral Regurgitation]]
* [[Left ventriculography Left Ventricular Ejection Fraction Assessment by Visual Estimation|Left Ventricular Ejection Fraction Assessment by Visual Estimation]]


==Vein and Arterial Bypass Graft==
==Vein and Arterial Bypass Graft==
|}
[[PCI in the left internal mammary artery|Left Internal Mammary Artery]]


{|width="50%" cellpadding="2" cellspacing="5" style="vertical-align:top; background:#f5fffa;"
==Performing Diagnostic Catheterization==
|-
! style="margin:0; background:#cedff2; font-size:120%; font-weight:bold; border:1px solid#a3b0bf; text-align:left; color:#000; padding:0.2em 0.4em; " colspan="2" | Section IV: Advanced Diagnostic and Therapeutic Angiography in PCI
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|style="color:#000; font-size:90%; vertical-align:top"|
 
==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]]
[[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 Catheterization===
[[Coronary angiography therapeutic procedures|Therapeutic procedures]] | [[Coronary angiography advances in catheter based physical treatments|Advances in catheter based physical treatments]]
[[Coronary angiography therapeutic procedures|Therapeutic procedures]] | [[Coronary angiography advances in catheter based physical treatments|Advances in catheter based physical treatments]]


==PCI in Specific Lesion Types==
===PCI in Specific Lesion Types===
[[PCI: classification of the lesion|Classification of the Lesion]] | [[PCI in the calcified lesion|The Calcified Lesion]] | [[PCI in the ostial lesion|The Ostial Lesion]] | [[PCI in the angulated or tortuous lesion|The Angulated or Tortuous Lesion]] | [[PCI in the bifurcation lesion|The Bifurcation Lesion]] | [[PCI in the long lesion|The Long Lesion]] | [[Myocardial bridge#PCI/Stenting|The Bridge Lesion]] | [[Coronary vasospasm#Treatment of PCI-induced Vasospasm|Vasospasm]] | [[Chronic total occlusions#PCI Techniques|The Chronic Total Occlusion]] | [[PCI in the left internal mammary artery|The Left Internal Mammary Artery]] | [[Multivessel coronary artery disease#Revascularization by Percutaneous Coronary Intervention (PCI)|Multivessel Disease]] | [[Treatment of distal anastomotic lesions#Balloon angioplasty (PTCA)|Distal Anastomotic Lesions]] | [[Left main intervention|Left Main Intervention]] | [[Management of the thrombotic lesion#Mechanical Therapy|The Thrombotic Lesion]]
[[PCI: classification of the lesion|Classification of the Lesion]] | [[PCI in the calcified lesion|The Calcified Lesion]] | [[PCI in the ostial lesion|The Ostial Lesion]] | [[PCI in the angulated or tortuous lesion|The Angulated or Tortuous Lesion]] | [[PCI in the bifurcation lesion|The Bifurcation Lesion]] | [[PCI in the long lesion|The Long Lesion]] | [[Myocardial bridge#PCI/Stenting|The Bridge Lesion]] | [[Coronary vasospasm#Treatment of PCI-induced Vasospasm|Vasospasm]] | [[Chronic total occlusions#PCI Techniques|The Chronic Total Occlusion]] | [[Multivessel coronary artery disease#Revascularization by Percutaneous Coronary Intervention (PCI)|Multivessel Disease]] | [[Treatment of distal anastomotic lesions#Balloon angioplasty (PTCA)|Distal Anastomotic Lesions]] | [[Left main intervention|Left Main Intervention]] | [[Management of the thrombotic lesion#Mechanical Therapy|The Thrombotic Lesion]]
 
==PCI Complications==
[[PCI complications: vessel perforation|Vessel Perforation]] | [[PCI complications: dissection|Dissection]] | [[PCI complications: distal embolization|Distal Embolization]] | [[PCI complications: no reflow|No-reflow]] | [[PCI complications: abrupt closure|Abrupt Closure]] | [[PCI complications: restenosis|Restenosis]] | [[PCI complications: late acquired stent malapposition|Late Acquired Stent Malapposition]] | [[PCI complications: loss of side branch|Loss of Side Branch]] | [[PCI complications: multiple complications|Multiple Complications]] | [[Coronary stent thrombosis]] | [[Slow flow]] | [[Pulsatile flow]] | [[Flow deceleration]] | [[Ectasia]] | [[Intimal flap]] | [[Staining]]
|}


===PCI Complications===
[[PCI complications: vessel perforation|Vessel Perforation]] | [[PCI complications: dissection|Dissection]] | [[PCI complications: distal embolization|Distal Embolization]] | [[PCI complications: no reflow|No-reflow]] | [[PCI complications: abrupt closure|Abrupt Closure]] | [[PCI complications: restenosis|Restenosis]] | [[PCI complications: late acquired stent malapposition|Late Acquired Stent Malapposition]] | [[PCI complications: loss of side branch|Loss of Side Branch]] | [[PCI complications: multiple complications|Multiple Complications]] | [[Coronary stent thrombosis]] | [[Slow flow]] | [[Pulsatile flow]] | [[Deceleration]] | [[Ectasia]] | [[Intimal flap]] | Staining | [[Coronary air embolism]]


{{Coronary Angiography}}
{{Coronary Angiography}}

Latest revision as of 05:07, 16 October 2021
Resident
Survival
Guide

Coronary Angiography

Home

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

Coronary Anatomy and Projection Angles

Normal Coronary Anatomy

Coronary Anatomic Variants

Projection Angles

Assessment of Perfusion

How to Assess Epicardial Coronary Blood Flow

How to Assess Myocardial Perfusion

Assessment of Lesion Morphology

Lesion Complexity

Thrombus Grades

Lesion Morphology

Left Ventriculography

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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