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Morphometric analysis of coronary lesions in patients with unstable angina--an arteriographic study
1Nizam's Institute of Medical Sciences, Hyderabad.
Insights
Type II eccentric lesions, often linked to ruptured plaques or thrombi, are common in unstable angina patients. This finding aids in understanding coronary artery disease morphology.
Area of Science:
- Cardiology
- Medical Imaging
- Pathology
Background:
- Unstable angina (UA) is a critical manifestation of coronary artery disease (CAD).
- Understanding the morphology of coronary artery lesions is crucial for diagnosing and managing UA.
- Qualitative assessment of lesion morphology can provide insights into plaque characteristics and instability.
Purpose of the Study:
- To compare the qualitative morphology of coronary artery lesions in patients with unstable angina versus stable angina.
- To identify specific lesion characteristics associated with unstable angina.
- To correlate lesion morphology with clinical presentation and extent of CAD.
Main Methods:
- Coronary angiography was performed in 150 patients (100 with UA, 50 with stable angina).
- Lesions causing >50% diameter stenosis were categorized morphologically: concentric stenosis, Type I eccentric, Type II eccentric, and multiple irregularities.
- Presence of thrombus was noted.
Main Results:
- Type II eccentric lesions (narrow neck, irregular edges) were significantly more frequent in the unstable angina group (47 vessels) compared to other morphologies.
- Concentric stenosis (18 vessels), Type I eccentric lesions (20 vessels), and multiple irregularities (15 vessels) were also observed.
- Thrombus was associated with lesions in 9 vessels.
Conclusions:
- Type II eccentric lesions are a prominent feature in patients with unstable angina.
- These lesions likely represent ruptured atherosclerotic plaques or partially occlusive thrombi, contributing to acute coronary events.
- Morphological analysis of coronary lesions via angiography is valuable for understanding UA pathophysiology.
Abstract:
In 100 patients with unstable angina and 50 patients with stable angina qualitative morphology of coronary artery lesions were compared by angiography. The mean age of the patients was 51 years. In the unstable angina group, 50 patients had rest angina, 32 had crescendo angina and 18 had denovo angina; 31 patients had single vessel disease, 33 had two vessel disease, 34 had triple vessel disease and 2 had left main disease. 'Angina-producing' artery could be identified in 90 out of 100 patients. Ten totally occluded vessels were excluded from analysis. Lesions causing diameter stenosis of greater than 50% could be categorised to one of the following groups: a) Concentric stenosis (18 vessels), b) Type I eccentric lesion (asymmetric narrowing with smooth borders and broad neck--20 vessels), c) Type II eccentric lesion (asymmetric narrowing with narrow neck and overhanging irregular edges--47 vessels), and d) Multiple irregularities (15 vessels). Lesions in 9 vessels showed an associated thrombus. It appears that Type II eccentric lesions are frequent in patients with unstable angina; they probably represent ruptured atherosclerotic plaque or partially occlusive thrombi or both.