Coronary artery tortuosity: Difference between revisions

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Severe [[vessel]] [[tortuosity]] and the presence of eccentric angulated [[lesion]]s have long been identified as significant predictors of percutaneous coronary intervention (PCI) failure, as well as worse clinical outcomes<ref name="pmid15219518">{{cite journal| author=Gibson CM, Bigelow B, James D, Tepper MR, Murphy SA, Kirtane AJ et al.| title=Association of lesion complexity following fibrinolytic administration with mortality in ST-elevation myocardial infarction. | journal=Am J Cardiol | year= 2004 | volume= 94 | issue= 1 | pages= 108-11 | pmid=15219518 | doi=10.1016/j.amjcard.2004.03.038 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15219518  }} </ref>. Challenges in the treatment of angulated [[lesion]]s and [[lesion]]s in tortuous segments includes difficulty in delivering the interventional equipment and the increased risk of [[vessel]] [[dissection]] and [[vessel perforation]].
Severe [[vessel]] [[tortuosity]] and the presence of eccentric angulated [[lesion]]s have long been identified as significant predictors of percutaneous coronary intervention (PCI) failure, as well as worse clinical outcomes<ref name="pmid15219518">{{cite journal| author=Gibson CM, Bigelow B, James D, Tepper MR, Murphy SA, Kirtane AJ et al.| title=Association of lesion complexity following fibrinolytic administration with mortality in ST-elevation myocardial infarction. | journal=Am J Cardiol | year= 2004 | volume= 94 | issue= 1 | pages= 108-11 | pmid=15219518 | doi=10.1016/j.amjcard.2004.03.038 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15219518  }} </ref>. Challenges in the treatment of angulated [[lesion]]s and [[lesion]]s in tortuous segments includes difficulty in delivering the interventional equipment and the increased risk of [[vessel]] [[dissection]] and [[vessel perforation]].


==Treatment==
==[[PCI in the angulated or tortuous lesion]]==





Revision as of 14:16, 17 December 2013

Coronary Angiography

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Historical Perspective
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Appropriate Use Criteria for Revascularization
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Technique
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Epicardial Flow & Myocardial Perfusion

Epicardial Flow

TIMI Frame Count
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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
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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
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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: Serpentine coronary artery

Overview

Coronary tortuosity (CT) is a common finding in coronary angiography settings. Although the unclear clinical importance of this phenomenon, the importance of CT comes from the possibility of reducing the coronary blood supply, through the reduced coronary perfusion pressure distal to the tortuous point of the coronary artery, as a result to this kinking and tortuosity, which may lead to ischemia.[1]

Definition

Although coronary artery tortuosity still has unclear fixed definition, some authors describe this phenomenon as a fixed ≥3 bends during both systole and diastole, in at least a single epicardial artery, with each bend ≥45° change in the vessel direction.[2] On the other hand, severe CT is described as a two following 180°turns of a major epicardial artery.[3]

Pathophysiology

Coronary artery tortuosity pathophysiology is still unclear, and it is believed to be a result of an arterial remodeling due to elastin degeneration in the arterial wall.[4] Elastin degeneration may occur with age, atherosclerosis, hypertension, aneurysms, ectasias, and diabetes mellitus.[5]

CT can result from a congenital defect, as with the arterial tortuosity syndrome, which is an autosomal recessive connective tissue condition, and characterized by generalised tortuosity and elongation of all major arteries, and involvement of the skin, joints, and other organs.[6]

Diagnosis

Coronary Angiography

A highly curved or tortuous vessel segment may result in substantial foreshortening of the artery. The length of the stenosis should therefore be assessed in the most unforeshortened projection so that the appropriate length of stents and balloons can be selected.

Clinical Significance

Severe vessel tortuosity and the presence of eccentric angulated lesions have long been identified as significant predictors of percutaneous coronary intervention (PCI) failure, as well as worse clinical outcomes[7]. Challenges in the treatment of angulated lesions and lesions in tortuous segments includes difficulty in delivering the interventional equipment and the increased risk of vessel dissection and vessel perforation.

PCI in the angulated or tortuous lesion

Example

References

  1. Zegers ES, Meursing BT, Zegers EB, Oude Ophuis AJ (2007). "Coronary tortuosity: a long and winding road". Neth Heart J. 15 (5): 191–5. PMC 1877966. PMID 17612682.
  2. Turgut O, Yilmaz A, Yalta K, Yilmaz BM, Ozyol A, Kendirlioglu O; et al. (2007). "Tortuosity of coronary arteries: an indicator for impaired left ventricular relaxation?". Int J Cardiovasc Imaging. 23 (6): 671–7. doi:10.1007/s10554-006-9186-4. PMID 17216126.
  3. Groves SS, Jain AC, Warden BE, Gharib W, Beto RJ (2009). "Severe coronary tortuosity and the relationship to significant coronary artery disease". W V Med J. 105 (4): 14–7. PMID 19585899.
  4. Panduranga P, Riyami AA (2011). "Serpentine coronary arteries: in a patient with apical hypertrophic cardiomyopathy". Tex Heart Inst J. 38 (5): 594–5. PMC 3231533. PMID 22163145.
  5. Dobrin PB, Schwarcz TH, Baker WH (1988). "Mechanisms of arterial and aneurysmal tortuosity". Surgery. 104 (3): 568–71. PMID 3413685.
  6. Pletcher BA, Fox JE, Boxer RA, Singh S, Blumenthal D, Cohen T; et al. (1996). "Four sibs with arterial tortuosity: description and review of the literature". Am J Med Genet. 66 (2): 121–8. doi:10.1002/(SICI)1096-8628(19961211)66:2<121::AID-AJMG1>3.0.CO;2-U. PMID 8958317.
  7. Gibson CM, Bigelow B, James D, Tepper MR, Murphy SA, Kirtane AJ; et al. (2004). "Association of lesion complexity following fibrinolytic administration with mortality in ST-elevation myocardial infarction". Am J Cardiol. 94 (1): 108–11. doi:10.1016/j.amjcard.2004.03.038. PMID 15219518.


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