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Lesion Assessment

  • Stuart T. Higano
  • Amir Lerman
Chapter

Abstract

Although coronary angiography remains the principal method for imaging the coronary arteries, it has several limitations [1–3]. As a silhouette image of the vessel lumen, coronary angiography cannot readily image noncircular vessel lumens nor can it image the vessel wall. Noncircular lumens are seen after plaque rupture or percutaneous coronary intervention (PCI) when there are ulcers, dissections, and intraluminal thrombus (often termed hazy appearance). Contrast streaming, ostial lesions, heavy calcification, and bifurcations with overlapping segments further complicate the coronary angiographic assessment of the vessel lumen. An early stage of plaque development results in outward growth, or positive remodeling, and plaque progression occurs without causing an angiographic stenosis. Even when the vessel lumen is well projected and imaged, the physiologic significance of a coronary stenosis cannot always be determined by the angiogram itself, especially for intermediate stenoses of 50% to 70% diameter. The physiologic importance of a coronary stenosis depends in part on the myocardial territory subtended by the coronary stenosis.

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© Springer Science+Business Media New York 2003

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  • Stuart T. Higano
  • Amir Lerman

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