Abstract
The rapid rise of new percutaneous coronary intervention (PCI) techniques and devices has necessitated standardized methods of evaluating coronary artery disease (CAD) severity and the effect of treatments on the natural history of the disease. Coronary angiography is the gold standard for evaluating coronary artery disease (CAD), but subjective evaluation of angiographically apparent CAD is limited by high levels of intra- and inter-observer variability. Thus, methods and algorithms for quantitative coronary angiography (QCA) have been developed in order to objectively quantify the extent of CAD. This chapter will discuss proper techniques for angiographic image acquisition, the current tools and practice of quantitative angiographic analysis, and common angiographic measurement parameters.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
References
DeRouen TA, Murray JA, Owen W. Variability in the analysis of coronary arteriograms. Circulation. 1977;55(2):324–8.
Katritsis D, Lythall DA, Cooper IC, Crowther A, Webb-Peploe MM. Assessment of coronary angioplasty: comparison of visual assessment, hand-held caliper measurement and automated digital quantitation. Cathet Cardiovasc Diagn. 1988;15(4):237–42.
Fisher LD, Judkins MP, Lesperance J, et al. Reproducibility of coronary arteriographic reading in the coronary artery surgery study (CASS). Cathet Cardiovasc Diagn. 1982;8(6):565–75.
Ryan TJ, Faxon DP, Gunnar RM, et al. Guidelines for percutaneous transluminal coronary angioplasty. A report of the American College of Cardiology/American Heart Association Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures (Subcommittee on Percutaneous Transluminal Coronary Angioplasty). Circulation. 1988;78(2):486–502.
Smith S, Feldman T, Hirshfeld J, et al. ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention–summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervention). Circulation. 2006;113(1):156–75.
Fleming RM, Kirkeeide RL, Smalling RW, Gould KL. Patterns in visual interpretation of coronary arteriograms as detected by quantitative coronary arteriography. J Am Coll Cardiol. 1991;18(4):945–51.
Bertrand ME, Lablanche JM, Bauters C, Leroy F, Mac Fadden E. Discordant results of visual and quantitative estimates of stenosis severity before and after coronary angioplasty. Cathet Cardiovasc Diagn. 1993;28(1):1–6.
Desmet W, Willems J, Van Lierde J, Piessens J. Discrepancy between visual estimation and computer-assisted measurement of lesion severity before and after coronary angioplasty. Cathet Cardiovasc Diagn. 1994;31(3):192–8.
Kalbfleisch SJ, McGillem MJ, Pinto IM, Kavanaugh KM, DeBoe SF, Mancini GB. Comparison of automated quantitative coronary angiography with caliper measurements of percent diameter stenosis. Am J Cardiol. 1990;65(18):1181–4.
Reiber JH, Serruys PW, Kooijman CJ, et al. Assessment of short-, medium-, and long-term variations in arterial dimensions from computer-assisted quantitation of coronary cineangiograms. Circulation. 1985;71(2):280–8.
Mancini GB, Simon SB, McGillem MJ, LeFree MT, Friedman HZ, Vogel RA. Automated quantitative coronary arteriography: morphologic and physiologic validation in vivo of a rapid digital angiographic method. Circulation. 1987;75(2):452–60.
Spears JR, Sandor T, Als AV, et al. Computerized image analysis for quantitative measurement of vessel diameter from cineangiograms. Circulation. 1983;68(2):453–61.
Herrington DM, Siebes M, Walford GD. Sources of error in quantitative coronary angiography. Cathet Cardiovasc Diagn. 1993;29(4):314–21.
Hausleiter J, Jost S, Nolte CW, et al. Comparative in-vitro validation of eight first- and second-generation quantitative coronary angiography systems. Coron Artery Dis. 1997;8(2):83–90.
Van Herck PL, Gavit L, Gorissen P, et al. Quantitative coronary arteriography on digital flat-panel system. Catheter Cardiovasc Interv. 2004;63(2):192–200.
van der Zwet PM, Reiber JH. A new approach for the quantification of complex lesion morphology: the gradient field transform; basic principles and validation results. J Am Coll Cardiol. 1994;24(1):216–24.
Gradaus R, Mathies K, Breithardt G, Bocker D. Clinical assessment of a new real time 3D quantitative coronary angiography system: evaluation in stented vessel segments. Catheter Cardiovasc Interv. 2006;68(1):44–9.
Ramcharitar S, Daeman J, Patterson M, et al. First direct in vivo comparison of two commercially available three-dimensional quantitative coronary angiography systems. Catheter Cardiovasc Interv. 2008;71(1):44–50.
Dvir D, Marom H, Guetta V, Kornowski R. Three-dimensional coronary reconstruction from routine single-plane coronary angiograms: in vivo quantitative validation. Int J Cardiovasc Intervent. 2005;7(3):141–5.
Agostoni P, Biondi-Zoccai G, Van Langenhove G, et al. Comparison of assessment of native coronary arteries by standard versus three-dimensional coronary angiography. Am J Cardiol. 2008;102(3):272–9.
Schuurbiers JC, Lopez NG, Ligthart J, et al. In vivo validation of CAAS QCA-3D coronary reconstruction using fusion of angiography and intravascular ultrasound (ANGUS). Catheter Cardiovasc Interv. 2009;73(5):620–6.
Tsuchida K, van der Giessen WJ, Patterson M, et al. In vivo validation of a novel three-dimensional quantitative coronary angiography system (CardiOp-B): comparison with a conventional two-dimensional system (CAAS II) and with special reference to optical coherence tomography. EuroIntervention. 2007;3(1):100–8.
Meerkin D, Marom H, Cohen-Biton O, Einav S. Three-dimensional vessel analyses provide more accurate length estimations than the gold standard QCA. J Interv Cardiol. 2010;23(2):152–9.
Wellnhofer E, Wahle A, Mugaragu I, Gross J, Oswald H, Fleck E. Validation of an accurate method for three-dimensional reconstruction and quantitative assessment of volumes, lengths and diameters of coronary vascular branches and segments from biplane angiographic projections. Int J Card Imaging. 1999;15(5):339–53. discussion 355–336.
Tu S, Koning G, Jukema W, Reiber JH. Assessment of obstruction length and optimal viewing angle from biplane X-ray angiograms. Int J Cardiovasc Imaging. 2010;26(1):5–17.
Glagov S, Weisenberg E, Zarins CK, Stankunavicius R, Kolettis GJ. Compensatory enlargement of human atherosclerotic coronary arteries. N Engl J Med. 1987;316(22):1371–5.
Stiel GM, Stiel LS, Schofer J, Donath K, Mathey DG. Impact of compensatory enlargement of atherosclerotic coronary arteries on angiographic assessment of coronary artery disease. Circulation. 1989;80(6):1603–9.
Krone R, Shaw R, Klein L, et al. Evaluation of the American College of Cardiology/American Heart Association and the Society for Coronary Angiography and Interventions lesion classification system in the current “stent era” of coronary interventions (from the ACC-National Cardiovascular Data Registry). Am J Cardiol. 2003;92(4):389–94.
Singh M, Rihal CS, Lennon RJ, Garratt KN, Holmes DR. Comparison of Mayo Clinic risk score and American College of Cardiology/American Heart Association lesion classification in the prediction of adverse cardiovascular outcome following percutaneous coronary interventions. J Am Coll Cardiol. 2004;44:357–61.
Popma JJ, Leon MB, Moses JW, et al. Quantitative assessment of angiographic restenosis after sirolimus-eluting stent implantation in native coronary arteries. Circulation. 2004;110:3773–80.
Gobeil F, Lefevre T, Guyon P, et al. Stenting of bifurcation lesions using the Bestent: a prospective dual-center study. Catheter Cardiovasc Interv. 2002;55:427–33.
Medina A, de Lezo J. A new classification of coronary bifurcation lesions. Rev Esp Cardiol. 2006;59(2):183–4.
Lefevre T, Louvard Y, Morice MC, et al. Stenting of bifurcation lesions: classification, treatments, and results. Catheter Cardiovasc Interv. 2000;49:274–83.
Seiler C. The human coronary collateral circulation. Heart (England). 2003;89:1352–7.
Gibson CM, Cannon CP, Daley WL, et al. TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation. 1996;93(5):879–88.
Stone GW, Brodie BR, Griffin JJ, et al. Prospective, multicenter study of the safety and feasibility of primary stenting in acute myocardial infarction: in-hospital and 30-day results of the PAMI stent pilot trial. Primary Angioplasty in Myocardial Infarction Stent Pilot Trial Investigators. J Am Coll Cardiol. 1998;31(1):23–30.
van ‘t Hof AW, Liem A, Suryapranata H, Hoorntje JC, de Boer MJ, Zijlstra F. Angiographic assessment of myocardial reperfusion in patients treated with primary angioplasty for acute myocardial infarction: myocardial blush grade. Zwolle Myocardial Infarction Study Group. Circulation. 1998;97(23)):2302–6.
Stone GW, Peterson MA, Lansky AJ, Dangas G, Mehran R, Leon MB. Impact of normalized myocardial perfusion after successful angioplasty in acute myocardial infarction. J Am Coll Cardiol. 2002;39(4):591–7.
Fasseas P, Orford JL, Panetta CJ, et al. Incidence, correlates, management, and clinical outcome of coronary perforation: analysis of 16,298 procedures. Am Heart J. 2004;147:140–5.
Dippel EJ, Kereiakes DJ, Tramuta DA, et al. Coronary perforation during percutaneous coronary intervention in the era of abciximab platelet glycoprotein IIb/IIIa blockade: an algorithm for percutaneous management. Catheter Cardiovasc Interv. 2001;52:279–86.
Javaid A, Buch AN, Satler LF, et al. Management and outcomes of coronary artery perforation during percutaneous coronary intervention. Am J Cardiol. 2006;98:911–14.
Klein LW. Coronary artery perforation during interventional procedures. Catheter Cardiovasc Interv. 2006;68:713–17.
Stankovic G, Orlic D, Corvaja N, et al. Incidence, predictors, in-hospital, and late outcomes of coronary artery perforations. Am J Cardiol. 2004;93:213–16.
Ellis SG, Ajluni S, Arnold AZ, et al. Increased coronary perforation in the new device era. Incidence, classification, management, and outcome. Circulation. 1994;90(6):p2725–30.
Lansky AJ, Yang YM, Khan Y, et al. Treatment of coronary artery perforations complicating percutaneous coronary intervention with a polytetrafluoroethylene-covered stent graft. Am J Cardiol. 2006;98:370–4.
Ellis SG, Popma JJ, Lasala JM, et al. Relationship between angiographic late loss and target lesion revascularization after coronary stent implantation: analysis from the TAXUS-IV trial. J Am Coll Cardiol. 2005;45:1193–200.
Pocock SJ, Lansky AJ, Mehran R, et al. Angiographic surrogate end points in drug-eluting stent trials: a systematic evaluation based on individual patient data from 11 randomized, controlled trials. J Am Coll Cardiol. 2008;51(1):23–32. doi:10.1016/j.jacc.2007.07.084
Mauri L, Orav EJ, Candia SC, Cutlip DE, Kuntz RE. Robustness of late lumen loss in discriminating drug-eluting stents across variable observational and randomized trials. Circulation. 2005;112:2833–9.
Pocock SJ, Lansky AJ, Mehran R, et al. Angiographic surrogate end points in drug-eluting stent trials: a systematic evaluation based on individual patient data from 11 randomized, controlled trials. J Am Coll Cardiol. 2008;51(1):23–32.
Mercado N, Boersma E, Wijns W, et al. Clinical and quantitative coronary angiographic predictors of coronary restenosis: a comparative analysis from the balloon-to-stent era. J Am Coll Cardiol. 2001;38(3):645–52.
Dauerman HL, Higgins PJ, Sparano AM, et al. Mechanical debulking versus balloon angioplasty for the treatment of true bifurcation lesions. J Am Coll Cardiol. 1998;32(7):1845–52.
Kandzari DE, Tcheng JE, Gersh BJ, et al. Relationship between infarct artery location, epicardial flow, and myocardial perfusion after primary percutaneous revascularization in acute myocardial infarction. Am Heart J. 2006;151(6):1288–95.
Califf RM, Phillips 3rd HR, Hindman MC, Mark DB, Lee KL, Behar VS, Johnson RA, Pryor DB, Rosati RA, Wagner GS, et al. Prognostic value of a coronary artery jeopardy score. J Am Coll Cardiol. 1985;5:1055–63.
Alderman EL, Stadius M. The angiographic definitions of the Bypass Angioplasty Revascularization Investigation. Coron Artery Dis. 1992;3:1189–207.
Chen SL, Chen JP, Mintz G, Xu B, Kan J, Ye F, Zhang J, Sun X, Xu Y, Jiang Q, Zhang A, Stone GW. Comparison between the ners (new risk stratification) score and the syntax (synergy between percutaneous coronary intervention with taxus and cardiac surgery) score in outcome prediction for unprotected left main stenting. JACC Cardiovasc Interv. 2010;3:632–41.
Garg S, Sarno G, Garcia-Garcia HM, Girasis C, Wykrzykowska J, Dawkins KD, Serruys PW. A new tool for the risk stratification of patients with complex coronary artery disease: the clinical syntax score. Circ Cardiovasc Interv. 2010;3:317–26.
Graham MM, Faris PD, Ghali WA, Galbraith PD, Norris CM, Badry JT, Mitchell LB, Curtis MJ, Knudtson ML. Validation of three myocardial jeopardy scores in a population-based cardiac catheterization cohort. Am Heart J. 2001;142:254–61.
Hamburger JN, Walsh SJ, Khurana R, Ding L, Gao M, Humphries KH, Carere R, Fung AY, Mildenberger RR, Simkus GJ, Webb JG, Buller CE. Percutaneous coronary intervention and 30-day mortality: the British Columbia PCI risk score. Catheter Cardiovasc Interv. 2009;74:377–85.
Lansky AJ, Goto K, Cristea E, Fahy M, Parise H, Feit F, Ohman EM, White HD, Alexander KP, Bertrand ME, Desmet W, Hamon M, Mehran R, Moses J, Leon M, Stone GW. Clinical and angiographic predictors of short- and long-term ischemic events in acute coronary syndromes: results from the acute catheterization and urgent intervention triage strategy (acuity) trial. Circ Cardiovasc Interv. 2010;3:308–16.
Sianos G, Morel MA, Kappetein AP, Morice MC, Colombo A, Dawkins K, van den Brand M, Van Dyck N, Russell ME, Mohr FW, Serruys PW. The syntax score: an angiographic tool grading the complexity of coronary artery disease. EuroIntervention. 2005;1:219–27.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2014 Springer-Verlag London
About this chapter
Cite this chapter
Lansky, A.J., Pietras, C., Haleem, K., Ng, V. (2014). Optimal Angiographic Technique and Quantitative Analysis. In: Thompson, C. (eds) Textbook of Cardiovascular Intervention. Springer, London. https://doi.org/10.1007/978-1-4471-4528-8_2
Download citation
DOI: https://doi.org/10.1007/978-1-4471-4528-8_2
Published:
Publisher Name: Springer, London
Print ISBN: 978-1-4471-4527-1
Online ISBN: 978-1-4471-4528-8
eBook Packages: MedicineMedicine (R0)