Limitations of coronary angiography: An underestimated problem?

Abstract

Summary: Angiographic imaging suffers from many limitations which may distort the diagnostic information obtained from coronary arteriograms. Radiographic features limiting precise coronary stenosis measurement are caused by the x-ray source, the image intensifier, and the chemical properties of the cinefilm. Biologic variations are introduced by fluctuations in angiographic contrast concentration and flow-or contrast-dependent coronary dilation. Random errors are also introduced by the selection of the radiographic projection and frame to be analyzed and the digitization of cineangiograms. These limitations and their significance in distorting quantitative information obtained from coronary angiograms are discussed in this review.

Intravascular Frequency-Domain Optical Coherence Tomography Assessment of Carotid Artery Disease in Symptomatic and Asymptomatic Patients

“…This newer light-based modality delivers resolution to 10 to 15 mm, giving it the highest imaging resolution of any currently available vascular imaging technique. In fact, a body of data obtained primarily in the coronary vasculature, with extensive histopathological validation, documents the utility of OCT not only in eliminating the angiographic pitfalls of stenosis determination imposed by plaque eccentricity (15,16) but also in the accurate identification of plaque components such as lipid, calcium, and fibrous tissue (17). In addition, OCT makes it possible to directly visualize and quantify thin-cap fibroatheroma (TCFA), intraluminal thrombus, calcified nodules, and vascular inflammation (18)(19)(20)(21)(22)(23)(24).…”

Comparison between two‐dimensional and three‐dimensional quantitative coronary angiography for the prediction of functional severity in true bifurcation lesions: Insights from the randomized DK‐CRUSH II, III, and IV trials

“…Therefore, the accurate assessment of bifurcation lesion dimensions prior to percutaneous coronary intervention (PCI) is required. However, conventional two‐dimensional (2D) QCA, even with a dedicated bifurcation analysis software, has inherent limitations .…”

Identifying stable coronary plaques with OCT technology

“…OCT can generate a clear and complete assessment of long coronary artery segments within a few seconds and allow for easier image interpretation compared with angiography (Figure ). OCT offers a representation of the true lumen diameter over the length of the entire pullback with no projection‐related error , foreshortening , or geometric distortion which are limitations of angiographic assessment .…”