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Published on: January 15, 2022
Epicardial Structural Coronary Disease: From Plaque Burden to Flow-Limiting Stenosis
Andrea Viceré1, Domenico Galante1, Ciro Pollio Benvenuto2
1Center of Excellence in Cardiovascular Sciences, Ospedale Isola Tiberina, Gemelli Isola, Via di Ponte Quattro Capi, Rome, Italy.
Abstract:
Epicardial structural coronary disease remains a principal mechanism of ischemia in chronic coronary syndromes. This article provides key definitions and summarizes the pathobiologic continuum from diffuse plaque burden to focal flow-limiting stenosis, highlighting why angiographic severity alone is an imperfect surrogate of ischemic potential. We then review contemporary invasive physiologic assessment of epicardial disease, including hyperemic and non-hyperemic pressure indices, pullback mapping to distinguish focal versus diffuse patterns, and the potential role of post-percutaneous coronary intervention (PCI) physiology in detecting residual flow limitation and guiding optimization. Integrating anatomy and physiology is essential for individualized management and physiologically meaningful revascularization.
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