Chapter 20
Interventional Approach in Small Vessel, Diffuse, and Tortuous Coronary Artery Disease
Saadat Aleem,
Puja Parikh,
Varun Bhasin,
Robert T. Pyo,
Saadat Aleem
Search for more papers by this authorPuja Parikh
Search for more papers by this authorVarun Bhasin
Search for more papers by this authorRobert T. Pyo
Search for more papers by this authorSaadat Aleem,
Puja Parikh,
Varun Bhasin,
Robert T. Pyo,
Saadat Aleem
Search for more papers by this authorPuja Parikh
Search for more papers by this authorVarun Bhasin
Search for more papers by this authorRobert T. Pyo
Search for more papers by this authorBook Editor(s):George D. Dangas MD, MACC, MSCAI, FAHA, FESC,
Carlo Di Mario MD, PhD, FRCP, FACC, FSCAI, FESC,
Holger Thiele MD,
Peter Barlis MBBS, MPH, PHD, FACC, FESC, FRACP,
Tayo Addo MD, Bimmer Claessen MD, Christian Hengstenberg MD, Nicholas Kipshidze MD,
George D. Dangas MD, MACC, MSCAI, FAHA, FESC
Professor of Medicine (Cardiology) & Surgery (Vascular) Professor of Cardiology Adjunct Professor of Internal Medicine
Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY, USA
National Kapodistrian University of Athens, Greece
Medical University of Vienna, Austria
Search for more papers by this authorCarlo Di Mario MD, PhD, FRCP, FACC, FSCAI, FESC
Professor of Cardiology Director of the Structural Interventional Cardiology Division Honorary Consultant
University of Florence
University Hospital Careggi, Florence, Italy
Cardiologist Royal Brompton Hospital, London, UK
Search for more papers by this authorHolger Thiele MD
Professor of Cardiology at University of Leipzig
Heart Center Leipzig at University of Leipzig, Leipzig, Germany
Search for more papers by this authorPeter Barlis MBBS, MPH, PHD, FACC, FESC, FRACP
Professor of Cardiology Interventional Cardiologist
University of Melbourne, Melbourne, Victoria, Australia
St Vincent's & Northern Hospitals Victoria, Australia
Search for more papers by this authorFirst published: 06 May 2022
Summary
Unfavorable factors for percutaneous coronary intervention (PCI) include small caliber of coronary vessels, diffuse lesion length and significant coronary artery tortuosity. Percutaneous interventions of small vessels are relatively common and compromise approximately 25–30% of coronary procedures. Physiologic assessment of small vessel coronary artery disease is important. Measurement of fractional flow reserve can be useful in assessing the physiologic significance of lesions in small coronary arteries. Optical coherence tomography is a relatively new imaging modality compared to intravascular ultrasound. Treatment of bifurcation lesion in small vessels should employ a one stent strategy. Diffuse coronary artery disease may develop in response to a general inflammatory process in patients with vasculopathies. Coronary angiography is most often used to identify diffuse coronary artery disease. Percutaneous intervention of tortuous coronary arteries with concomitant calcification can be particularly challenging. The key challenge is delivering stents past a calcified tortuous bend.
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