Angiographical classification of coronary artery disease from the viewpoint of complete revascularization Tohru Kobayashi 1 , Yoshiyuki Fudemoto 1 , Tadafumi Oda 1 , Takashi Yoshino 1 , Kiyoshi Fujimoto 1 , Kazuhiko Hirobe 2 1Division of Circulatory Dynamics, Center for Adult Diseases, Osaka 2Second Department of Internal Medicine, Osaka University School of Medicine pp.889-896
Published Date 1983/8/15
DOI https://doi.org/10.11477/mf.1404204284
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Coronary arteriography using cranial and caudal angulation was undertaken in 73 patients (MI 31, angina pectoris 42) with more than 75% luminalnarrowing of AFIA coronary angiographic classifica-tion.

Lesions of coronary arteriosclerosis were classified into 3 types due to the location of stenosis : type 1 is the lesions located in the main coronary arteries such as LAD, LCX and RCA, type 2 is the stenoses at the branching portion of the main coronary arteries and the origin of the branches such as diagonal, obtuse marginal, posterior descending and posterior left ventricular branches, type 3 is the narrowings localized in the branches. The branches with small caliber less than 1.0 mm were excluded in this classification.

From the viewpoint of complete revasculariza-tion, the lesions of type 2 require two grafts, one to the main coronary artery and the other to the branch. Mixed types, which variably combine type 1, type 2 and type 3, also necessitate two grafts or more, although single graft is enough for type 1 or type 3.

Of 64 patients with the stenoses in LAD region, 23 patients (36%) had the lesions of type 1, 10 (16%) type 2,4 (6%) type 3 and 27 (42%) mixed types. Two or more grafts were subsequently indicated in the region of LAD in 37 patients (58%).

Thirty-four patients revealed the narrowings in LCX region. Type 1 was found in 9 patients (26%), type 2 in 4 (12%), type 3 in 8 (24%) and mixed types in 13 (38%). Seventeen patients (50%) with type 2 or mixed types were judged to need two or more grafts in LCX region.

There were 42 patients with the stenotic lesions in RCA, of which 26 (62%) showed type 1 stenosis, one type 2,4 (10%) type 3 and 11 (26%) mixed types. Single graft was enough in 72% of patients with RCA lesions.

In order to evaluate exactly the location of stenotic lesions, which may or may not include the origin of branches, hemiaxial angulation is frequently diagnostic. Cranial angulation in LAO is valuable for proximal LAD lesions and distal RCA lesions. Caudal angulation is useful for the detection of stenosis in ramus medialis.

Copyright © 1983, Igaku-Shoin Ltd. All rights reserved.


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