Accuracy of angiographic determination of left main coronary arterial narrowing. Angiographic--histologic correlative analysis in 28 patients.

In the present report we examine the accuracy of coronary angiography in evaluating the left main coronary artery by comparing the results of antemortem angiography to histologic observations at necropsy

J M Isner; J Kishel; K M Kent; J A Ronan; A M Ross; W C Roberts

2011

Scholarcy highlights

  • In the present report we examine the accuracy of coronary angiography in evaluating the left main coronary artery by comparing the results of antemortem angiography to histologic observations at necropsy
  • Of the 12 patients in whom the LMCA was narrowed 76-100% in cross-sectional area, angiography underestimated the degree of LMCA narrowing in six
  • In the 12 patients in whom the LMCA was narrowed 51-75% in cross-sectional area at necropsy, angiography underestimated the degree of LMCA
  • (> 75% in cross-sectional area) has been determined to be as high as 39%.`8 Quantitative histologic examination of the coronary arteries at necropsy has indicated that two morphologic features in particular account for the tendency to underestimate degrees of coronary narrowing: the coronary atherosclerotic process is diffuse, rather than focal, and the residual nonoccluded lumen is usually eccentric in location and often slit-like in shape."8' 19 Diffuse narrowing forces the angiographer to compare sites of maximal narrowing to adjacent sites that may be less, but still severely narrowed; rarely, does the angiographer have a truly normal, uncompromised luminal diameter on which to base estimates of percent coronary luminal diameter reduction
  • Because for any degree of diameter reduction there is a greater degree of cross-sectional area narrowing, an angiographic underestimation was defined as an angiographic judgment that underestimated the degree of cross-sectional area narrowing by an absolute difference of > 25% or more
  • Of the six patients in whom LMCA narrowing of > 75% in cross-sectional area was underestimated, none was viewed in the anteroposterior projection and only three patients were examined in very shallow obliquities
  • Of the seven patients in whom the left main coronary artery was narrowed 51-75% in cross-sectional area and was underestimated angiographically, only two were viewed in the anteroposterior projection and only five in a very shallow obliquity

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