In this book, the importance and value of accurately assessing coronary stenosis morphology is reviewed, including recent thoughts regarding the pathogenetic mechanisms ascribed to angiographically assessed morphology, several new and potentially more accurate means of determining plaque composition and its relationship to stenosis morphology, and the latest hypotheses regarding interventional device selection.
Each chapter has been written by acknowledged experts in the area, who have contributed significantly to that body of knowledge and are considered opinion leaders nationally and internationally. Each chapter contains the basic `how-to' of that technique, the manner in which it is best utilized or considered, and the limitations that must be taken into account in its application. In some chapters, the authors address guidelines regarding image acquisition and analysis to minimize the variations resulting from the potential error sources.
It is hoped that this work will lead to technological developments, improved performance, and more rational clinical utilization.
Introduction: Clinical Analysis and Utilization of Coronary Stenosis Morphology; L.W. Klein. Section One: Assessment of Stenosis Morphology. 1. Morphologic Analysis of Coronary Stenoses by Coronary Angiography: Subjective Variability and Accuracy; N.M. Lakkis, N. Kleiman. 2. Intravascular Ultrasound: Equipment, Technique and Applications in Clinical Practice and Research; S. Nissen, L.W. Klein. 3. Quantitative Analysis of Lesion Morphology by Computerized Techniques; G.B.J. Mancini, G. Hudon. 4. Intravascular Angioscopy in the Analysis of Stenosis Morphologic and Composition: Therapeutic Implications; S. Feld, R. Smalling. 5. Computerized Three-Dimension Intravascular Reconstruction; R.R. Heuser, et al. Section Two: Implications of Stenosis Morphology on Pathogenesis. 6. Coronary Stenosis Morphology: The Importance of Lesion Length, Stenosis Eccentricity, Severity, and Coronary Blood Flow in Clinical Decision Making; M. Kern, et al. 7. Angiographic Stenosis and Acute Coronary Syndromes: Progression of Stenoses to Myocardial Infarction; W. Little, R.J. Applegate. 8. Unstable Angina and Non-Q Wave Myocardial Infarction: Pathogenetic Mechanisms and Morphology of the Unstable Plaque; L.W. Klein. 9. Defining Coronary Pathology and Clinical Syndromes by Coronary Angioscopy; J. Forrester, et al. 10. Usefulness of Intravascular Ultrasound for Detecting Atherosclerosis Progression or Regression; M.K. Hong, et al. Section Three: Selection of Treatment Options Guided by Morphologic Assessment. 11. Stenosis Morphology and Risk Assessmentin Balloon Angioplasty; S. Ellis, K.-H. Mak. 12. Intravascular Ultrasound-Guided Selection of New Coronary Devices in Coronary Intervention; S. Higano, D.R. Holmes. 13. Lesion Morphology and Composition: Risk of Restenosis Following Coronary Interventions; B. Strauss, M.K. Natarajan. 14. Pitfalls and Practical Approach to the Use of Imaging Techniques in Developing Clinical Strategies; T.R. Bowers, et al.