Arteriographic assessment of coronary atherosclerosis. Review of current methods, their limitations, and clinical applications.

ABSTRACT

Coronary arteriography is presently the definitive procedure for characterizing the location and severity of coronary atherosclerosis; and despite certain reported limitations, we believe that the properly performed coronary arteriogram provides a true picture of the arterial lumen in life. Yet this widely-used clinical tool is currently limited by imprecise and, to a certain extent, inappropriate subjective methods of interpretation. More objective methods for analysis of the arteriographic information content have been described. These include caliper- and vernier- based systems for measuring relative arterial narrowing, computer-assisted methods for making accurate measurements of absolute stenosis dimensions, and photodensitometric methods for extracting three-dimensional information from a planar image of the stenosis. The availability of these objective techniques has resulted in a considerable increase in our understanding of pathogenic mechanisms in coronary disease. Advances include an expanded understanding of the mechanisms of action of nitroglycerin and verapamil and of the coronary artery constriction induced by drugs of isometric stress. Stenosis measurements have served as the basis for evaluation of certain noninvasive techniques used to detect coronary disease. An analytical approach has been developed to characterize the progression (and regression) of coronary disease from serial arteriograms. We believe clinical investigations based on these techniques hold considerable promise for further advances in the understanding of human coronary pathophysiology.