PCI in the angulated or tortuous lesion
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Editors-In-Chief: C. Michael Gibson, M.D., Alexandra Almonacid M.D., and Jeffrey J. Popma M.D.
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Overview
Severe tortuosity and moderate-to-severe calcification have long been identified as significant predictors of procedure failure, as well as worse clinical outcomes.
Angulated Lesions
- Balloon angioplasty of highly angulated lesions is associated with an increased for risk coronary dissection.
- In the settings of coronary stenting, angulated lesions represent a challenge due to the inability of delivering the stent to the stenosis and straightening of the arterial silhouette after stent implantation that may predispose to the presence of stent fracture.
- Vessel curvature at the site of maximum stenosis should be measured in the most unforeshortened projection using a length of curvature that approximates the balloon length used for coronary dilation.
Goals of Treatment
In the treatment of angulated and tortuous lesions, the main goals include successfully delivering the equipment, avoiding complications, and maximizing procedural success. Complications to avoid include vessel perforation, dissection, and premature stent deployment. Procedural success includes the restoration of normal epicardial flow and myocardial perfusion.