Our Preoccupation With Coronary Luminology

We reported that such atheromas are virtually always present in ergonovine-positive patients with a “normal” angiogram.19

Eric J. Topol; Steven E. Nissen

2012

Scholarcy highlights

  • 40 years after its invention, the angiogram is still considered by most physicians to be the “gold standard” for defining coronary anatomy
  • Cardiologists have increasingly relied on coronary angiography to guide both clinical practice and research, with more than a million procedures performed annually in the United States
  • Many research studies, in thrombolysis and intervention, have used computerized measurement techniques, a process known as quantitative coronary angiography
  • Coronary angiography has had a profound impact on the diagnosis and management of ischemic heart disease, setting up the potential for both surgical and percutaneous coronary revascularization and the foundation for contemporary myocardial reperfusion therapy
  • The purpose of this article is to outline the evidence that our current preoccupation with coronary luminology may be significantly misguided and to propose a rational paradigm for future clinical practice and investigation
  • The inattention to atherectomy-related complications appears confined to the United States; outside this country, fewer than 3% of patients having percutaneous interventions undergo directional atherectomy
  • In the development of directional atherectomy, studies showed that debulking of plaque resulted in improved luminal caliber compared with balloon dilatation. This difference in lumen size between atherectomy and angioplasty was validated in the Coronary Angioplasty Versus Excisional Atherectomy Trial and Canadian Coronary Atherectomy Trial
  • In addition to closely tracking clinical end points, future trials of restenosis and new interventional devices should not rely exclusively on measurements obtained from an angiographic silhouette.8485 Intravascular ultrasound dimensions are frequently divergent from quantitative angiographic measurements, whereas the tomographic perspective of ultrasound provides unique insights into the mechanism, shape, and extent of lumen enlargement

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