Coronary angiography postprocedural 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]

Overview

Feature	Definition
Abrupt closure	Obstruction of contrast flow (TIMI 0 or 1) in a dilated segment with previously documented anterograde flow
Ectesia	A lesion diameter greater than the reference diameter in one or more areas
Luminal irregularities	Arterial contour that has a “sawtooth pattern” consisting of opacification but not fulfilling the criteria for dissection or intracoronary thrombus
Intimal flap	A discrete filling defect in apparent continuity with the arterial wall
Thrombus	Discrete, mobile angiographic filling defect with or without contrast staining
Dissection*
____ A	Small radiolucent area within the lumen of the vessel
____ B	Linear, nonpersisting extravasation of contrast
____ C	Extraluminal, persisting extravasation of contrast
____ D	Spiral-shaped filling defect
____ E	Persistent lumen defect with delayed anterograde flow
____ F	Filling defect accompanied by total coronary occlusion
____ Length	Measure end-to-end for type B through F dissections
____ Staining	Persistence of contrast within the dissection after washout of contrast from the remaining portion of the vessel
Perforation
____ Localized	Extravasation of contrast confined to the pericardial space immediately surrounding the artery and not associated with clinical tamponade
____ Nonlocalized	Extravasation of contrast with a jet not localized to the pericardial space, potentially associated with clinical tamponade
Side branch loss	TIMI 0, 1, or 2 flow in a side branch >1.5 mm in diameter that previously had TIMI 3 flow
Distal embolization	Migration of a filling defect or thrombus to distally occlude the target vessel or one of its branches
Coronary spasm	Transient or permanent narrowing >50% when a <25% stenosis was previously noted

References

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