Grading of coronary atherosclerosis Comparison of a modified IAP visual grading method and a new quantitative angiographic technique

Crawford, Donald W.; Beckenbach, Edwin S.; Blankenhorn, David H.; Selzer, Robert H.; Brooks, Samuel H.

doi:10.1016/0021-9150(74)90058-6

Cited by 28 publications

(1 citation statement)

References 5 publications

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“…Blankenhorn and associates4' 5 have developed a potentially useful method for detecting the presence of intimal fibrous plaques. They measure vessel lumen irregularity using edge detection by scanning densitometry and computerized curve fitting.…”

mentioning

confidence: 99%

Quantitative coronary arteriography: estimation of dimensions, hemodynamic resistance, and atheroma mass of coronary artery lesions using the arteriogram and digital computation.

Brown¹,

Bolson²,

Frimer³

et al. 1977

Circulation

628

147

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More accurate characterization of coronary artery lesions is needed for evaluation of short and long-term interventions in coronary disease. A method of segmental artery analysis has been developed to maximize the information obtained from coronary arteriograms. Coronary lesions are traced from two projected, perpendicular, 35 mm cineangiographic views and transmetted, in digital form, to a PDP 11/45 computer. Magnification and distortion of the image are compensated for in order to determine the actual vessel profiles, using the catheter and its location as a scaling device. The two views are matched; a spatial representation of the vessel centerline is constructed mathematically; and orthogonal vessel diameters are computed at increments along this centerline. Assuming an elliptical lumen, the absolute and percentage reduction in diameter and cross-sectional area in the stenosis are computed. More complex functions (integrated atheroma mass, Poiseuille resistance, and orifice resistance) are then calculated. The accuracy and variability of the different steps involved in lesion analysis have been determined. Dimensional accuracies of +/- 150 microns (SD) are feasible. Examples are given of patients with Prinzmetal's angina and with progressive coronary disease.

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mentioning

confidence: 99%

Quantitative coronary arteriography: estimation of dimensions, hemodynamic resistance, and atheroma mass of coronary artery lesions using the arteriogram and digital computation.

Brown¹,

Bolson²,

Frimer³

et al. 1977

Circulation

628

147

View full text Add to dashboard Cite

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Cross sectional coronary artery stenosis

Fester

Hildner

1977

Cathet. Cardiovasc. Diagn.

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Significant obstructive lesions must be demonstrated in the coronary arterial circulation before bypass surgery can be recommended as an effective therapeutic alternative. Nearly total occlusion of an artery is obviously of greater importance than minimal narrowing caused by an eccentrically placed, isolated mural plaque. Not as clear, however, is the significance of a 40% as compared with a 70% narrowing in a coronary artery, especially when the vessel is photographed over the vertebral column or diaphragm on a gray overpenetrated film recorded o n a 9" image screen. Under these conditions any debate concerning the obstructive characteristics of a given lesion would be valueless. But, given a first-quality angiogram obtained with a very small focal spot and high-resolution cesium iodide 6" image intensifier, a discussion of whether the 40% lesion is obstructive would probably be concerned with whether it was the only vessel obstructed or the only remaining vessel patent, whether that obstruction occurred at the bifurcation of the artery or in a relatively smooth part of the vessel, and of the greatest importance, whether or not the obstruction could be demonstrated in more than one projection. In short, the ultimate purpose of coronary arteriography is to accurately estimate crosssectional patency of the coronary arterial tree (1).At least four methods are currently available for use in estimating coronary occlusive disease. 1. Scanning densitometry and computerized curve fitting (2) relies on elaborate and relatively expensive equipment, but it is unsatisfactory for analysis of significant atherosclerotic lesions. 2. Analysis of coronary arterial disease by digital computer processing (3) requires that the angiographer prepare an elaborate schematic diagram of the coronary tree. The method is time-consuming and impractical for routine use. 3. Quantitative coronary arteriography using a three-dimensional computerized approach (4) requires approximately 20 min to evaluate each individual lesion. This technique is chiefly a research tool that is not yet applicable for clinical use. 4. Visual estimation of the degree of coronary obstruction is the simplest arid most popular method currently in use. The multiple limitations of this approach are generally well known. First, intra-and inter-reader variability is quite high. In certain instances estimates of a single vessel lesion have varied by as much as +36% (5,6). Second, since single-projection estimates are commonly used, eccentric narrowing may be interpreted with an error of nearly +300%.The cross-sectional narrowing of an obstructive lesion is the single most important consideration in the evaluation of any coronary hydrodynamic problem (7). This does not detract from the importance of other determinants of flow, such as perfusion pressure, length of lesion, shape of lesion, or blood viscosity, among

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Estimation of the effects of angioplasty on coronary stenosis using quantitative video angiography

Bové

Holmes²,

Owen³

et al. 1985

Cathet. Cardiovasc. Diagn.

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In this study, we compared stenosis severity by quantitative coronary angiography from video and cine images with visual estimation in 14 patients who underwent PTCA. Both cine and video analysis demonstrated a change from 65.2 +/- 2.5 to 36.5 +/- 3.1% diameter stenosis following PTCA, whereas visual estimation (average of three observers) showed improvement from 89.9 +/- 1.7 to 36.0 +/- 3.2%. Percent area stenosis from quantitative angiography showed improvement from 87.9 +/- 1.8 to 56.4 +/- 5.8. These data indicate that visual assessment overestimated percent diameter of severe lesions. To determine if video analysis could provide rapid quantitative assessment of PTCA results, we compared percent diameter and percent area stenosis by video with cine (diameter: correlation coefficient, 0.82; slope, 0.79; area: correlation coefficient, 0.86; slope, 0.83). These results indicate that video-based measurements are not different from cine-derived measurements. Quantitative coronary angiography provides an accurate estimate of changes produced by PTCA and can be performed rapidly and accurately on video images, thus making results available during the PTCA procedure.

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Grading of coronary atherosclerosis Comparison of a modified IAP visual grading method and a new quantitative angiographic technique

Cited by 28 publications

References 5 publications

Quantitative coronary arteriography: estimation of dimensions, hemodynamic resistance, and atheroma mass of coronary artery lesions using the arteriogram and digital computation.

Quantitative coronary arteriography: estimation of dimensions, hemodynamic resistance, and atheroma mass of coronary artery lesions using the arteriogram and digital computation.

Cross sectional coronary artery stenosis

Estimation of the effects of angioplasty on coronary stenosis using quantitative video angiography

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