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Assessment of stenosis severity

  • Chapter
State of the Art in Quantitative Coronary Arteriography

Part of the book series: Developments in Cardiovascular Medicine ((DICM,volume 53))

Summary

Visual interpretations of coronary arteriograms are marked by such great interobserver and intraobserver variability that comparison of arteriograms from different subjects, or at different times in the same subject, are of limited value for assessing severity, changes in severity or functional significance of coronary artery stenosis. The universal use of percent diameter narrowing as a clinical measure of severity ignores other geometric characteristics of stenoses such as length, absolute diameter, multiple lesions in series or eccentric narrowings which may be worse in one view as compared to another view. Accordingly, we have developed an approach for analyzing coronary artery stenoses in both anatomic and functional terms. In this chapter an overview of the functional and anatomic approaches for quantifying severity of coronary artery stenoses is presented, their validation and equivalence outlined and the remaining problems to be solved indicated.

Our quantitative analysis of coronary arteriograms requires high quality orthogonal X-rays processed in two different ways. In the first, the entire region of interest on the arteriogram is digitized with the borders of the arteriogram identified automatically utilizing an edge detection method in computer software without visual interpretation. In the second approach, the stenosis of interest is analyzed by integrating the optical density diametrically across the long axis of the artery image. The arterial cross-sectional areas measured by both techniques are automatically compared for each segment of the artery. The border recognition technique is accurate with a ± 0.1mm error for lesions that are not crescentic in shape to less than 0.5 mm diameter. However, for crescentic shaped lesions, border recognition is inadequate because the atheromatous mass may project into the arterial lumen within the limits of the X-ray borders. For crescentic lesions the integrated density technique is more accurate since the optical density across the artery reflects displacement of contrast media by a crescentic atheroma projecting into the lumen of the artery. Therefore, where the border recognition and integrated density technique do not agree, the integrated density method is used for determining the severity of the stenosis. The dimensions determined by these automated techniques are then incorporated into validated fluid dynamic equations in order to predict the functional, pressure-flow effects of the stenosis as well as coronary flow reserve. Our results demonstrate that our automated, quantitated coronary arteriographic analysis predicts pressure-flow characteristics or coronary flow reserve as a single measure of stenosis severity reflecting all the integrated, combined effects of the geometric characteristics of the lesion including absolute diameter, percent stenosis, length and shape. Our results further demonstrate that consideration of a single dimension alone such as percent diameter narrowing or absolute diameter alone do not correlate or predict with coronary flow reserve measured independently by flow meter.

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Authors
  1. K. Lance Gould
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  2. R. L. Kirkeeide
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Editors and Affiliations

  1. Department of Cardiology, Thorax Center, Erasmus University, Rotterdam, The Netherlands

    J. H. C. Reiber PhD  & P. W. Serruys MD  & 

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© 1986 Martinus Nijhoff Publishers, Dordrecht

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Gould, K.L., Kirkeeide, R.L. (1986). Assessment of stenosis severity. In: Reiber, J.H.C., Serruys, P.W. (eds) State of the Art in Quantitative Coronary Arteriography. Developments in Cardiovascular Medicine, vol 53. Springer, Dordrecht. https://doi.org/10.1007/978-94-009-4279-0_12

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  • DOI: https://doi.org/10.1007/978-94-009-4279-0_12

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