Irregular lesion

Coronary Angiography
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Lesion Complexity
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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
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The appearence of irregular lesions with intraluminal filling defects and contrast staining is detected by coronary angiography and may indicate a fissured atherosclerotic plaque with adherent thrombus.

Definition

A stenosis is classified as having irregular contour if the vascular margin is rough or has a "sawtooth" appearance.

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.
• 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.
• The lesion irregularity is the second most important risk factor of diameter stenosis as a predictor of future infarction.

References

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