Coronary Angiographic and Morphologic Correlation

Isner, Jeffrey M.; Donaldson, Roberta Fortin

doi:10.1016/s0733-8651(18)30712-4

Cited by 22 publications

(8 citation statements)

References 51 publications

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“…In-stent restenosis was defined as a stent lumen cross-sectional area stenosis of Ͼ75% (equivalent to a stent lumen diameter stenosis of Ͼ50%). 16 No restenosis was defined as a stent lumen area stenosis of Յ75% (equivalent to a stent lumen diameter stenosis of Յ50%).…”

Section: Selection Of Casesmentioning

confidence: 99%

Morphological Predictors of Restenosis After Coronary Stenting in Humans

et al. 2002

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Background — Experimental studies suggest that arterial injury and inflammation lead to increased neointimal growth after stenting. Despite the increased use of coronary stents in humans, there are only limited pathological data on the morphological features of in-stent restenosis. Methods and Results — Detailed histology was performed on 116 stents, implanted ≥90 days in 87 coronary arteries, from 56 patients (mean age, 59±13 years). The mean duration of stent implant was 10 months. In-stent restenosis was defined as a stent area stenosis of >75%. Lumen area increased as stent area increased ( r 2 =0.27, P =0.0001), but there was a much stronger correlation between stent area and neointimal area ( r 2 =0.70, P <0.0001). Arterial medial fracture was associated with a 29% increase ( P <0.01) in neointimal thickness compared with arteries with an intact media. Neointimal thickness ( P =0.0001), inflammatory cell density ( P <0.0001), and neointimal vascular channel density ( P <0.0001) were greater when struts were in contact with a ruptured arterial media compared with fibrous plaque or an intact fibrous cap. Stent strut penetration into a lipid core was associated with increased neointimal thickness ( P =0.04) and inflammatory cell density ( P =0.03). Neointimal inflammatory cell content was 2.4-fold greater in stents with restenosis versus no restenosis, and inflammation was associated with increased neoangiogenesis. Conclusions — Coronary stenting that is accompanied by medial damage or penetration of the stent into a lipid core induces increased arterial inflammation, which is associated with increased neointimal growth. These data suggest the use of stenting strategies that reduce inflammation and neoangiogenesis to reduce the incidence of restenosis.

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Section: Selection Of Casesmentioning

confidence: 99%

Morphological Predictors of Restenosis After Coronary Stenting in Humans

et al. 2002

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“…A similar fi nding was also observed in the other two patients with angiographically ostial LMCA disease (cases 2 and 3). This angiographic limitation was previously described by several studies [2][3][4]. Furthermore, the differences between CA and CCTA might be due to the fact that the appearance of an eccentric stenosis in CA depends on the availability of a projection showing the real MLD.…”

Section: Discussionmentioning

confidence: 94%

“…Furthermore, ostial LMCA lesions can be misjudged by CA most markedly in patients whose LMCA is moderately diseased [1][2][3][4].…”

Section: Introductionmentioning

confidence: 99%

Coronary CT Angiography Findings in Patients with Ambiguous Left Main Coronary Artery Disease

Zeina¹,

Rosenschein

Odeh

et al. 2008

Clinical medicine. Cardiology

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Left main coronary artery (LMCA) stenosis is a high risk subset of coronary artery disease; however, its occurrence may be misjudged by coronary angiography. Coronary CT angiography (CCTA) was performed on 5 patients with clinically highly suspicious and angiographically borderline LMCA disease (ostial: 3 patients, mid: 1 patient and distal: 1 patient). A cross-sectional CCTA image was used to calculate the diameter stenosis. The quantitative coronary angiography (QCA) reference diameter (RD) correlated well with CCTA RD in all 5 patients. However, the lesion site minimal lumen diameter (MLD) by QCA correlated less well with that obtained by CCTA. The grade of stenosis measured by CCTA was signifi cantly lower than that measured by QCA. Morphologically, three patients had LMCA ostial angulation (with minimal atheromatous changes), one patient had a biconcave confi guration of the LMCA (with normal vessel wall) and one other had a tapering-morphology of the LMCA (with minimal atheromatous changes). In conclusion, CCTA may have a complementary diagnostic role in patients with angiographically ambiguous or inconclusive LMCA lesions and therefore it should be considered in the assessment of selected patients before they undergo coronary bypass surgery. In order to validate CCTA for main stem stenosis a proper gold standard, such as IVUS, is required.

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“…While studies of the reproducibility of coronary angiography and its correlation with post-mortem findings have shown that the interpretation of angiography varies according to the operator but almost consistently underestimates the amount and significance of lesions [4][5][6][7], IVUS Fig. 1.…”

Section: Introductionmentioning

confidence: 99%

Intravascular Ultrasound: Technique, Measurements and Angioplasty Guidance

Gaster¹,

Thayssen²

2002

Heart Drug

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Coronary angiography has been the gold standard for decades for the evaluation of coronary artery disease. Although it offers the best overview of coronary artery anatomy, it has been known to underestimate the amount and severity of coronary artery lesions. This is probably due to the method being based on luminography, with the evaluation of the seat of coronary artery disease, the vessel wall, based on deduction. Intravascular ultrasound (IVUS) provides the investigator with the possibility of direct inspection of the vessel lumen as well as the vessel wall independently of vessel tortuosity, vessel overlap and ostial position. Thus, equivocal angiographically imaged vessels can be investigated by supplementing coronary angiography with IVUS. By guiding percutaneous coronary intervention with IVUS and angiography, a lower target vessel revascularisation rate can be expected, presumably due to the more physiologically correct device sizing possible. It seems that although IVUS guidance represents an incremental cost, long-term costs are reduced due to the lower revascularisation rates. Which lesions to guide by IVUS and angiography and which can be guided by angiography alone has still not been clarified in randomised trials.

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Coronary Angiographic and Morphologic Correlation

Cited by 22 publications

References 51 publications

Morphological Predictors of Restenosis After Coronary Stenting in Humans

Morphological Predictors of Restenosis After Coronary Stenting in Humans

Coronary CT Angiography Findings in Patients with Ambiguous Left Main Coronary Artery Disease

Intravascular Ultrasound: Technique, Measurements and Angioplasty Guidance

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