Fact-sheet: Coronary artery stenosis - Coronaropathy


Updated on 10/17/2024 at 7:18 AM

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Definition

Coronary artery disease is the accumulation of atheromatous plaques along the coronary arteries, narrowing their lumen and impairing myocardial perfusion

Clinical features

Exertional angina

Myocardial infarction

CT

Calcium score assessment on non-contrast acquisition with cardiac gating

Coronary artery analysis on coronary CT angiography, contrast-enhanced acquisition with cardiac gating.

  • For vessels > 1.5 mm in diameter, the percentage stenosis is based on measurement of the mean vessel diameter on cross-section
  • For vessels < 1.5 mm in diameter: qualitative assessment of stenosis

--> Describe plaque location, length, percentage stenosis, composition (calcified, non-calcified, mixed) and use the CAD-RADS 2.0 classification

Classification

CAD-RADS 2.0:

  • 0: normal coronary artery
  • 1: non-significant stenosis, 1 to 24%
  • 2: non-significant stenosis, 25 to 49%
  • 3: intermediate stenosis, 50 to 69%
  • 4: severe stenosis 4A: stenosis 70% to 99%
  • 4B: left main stenosis > 50% or three-vessel disease > 70%
  • 5: coronary occlusion

--> Report the most severe category as the overall CAD-RADS in the conclusion

  • CAD-RADS modifiers: High-risk plaque: presence of at least 2 features among positive remodeling, spotty calcification, low-attenuation plaque, pericoronary infiltration.
  • S: stent(s)
  • G: bypass graft(s)
  • E: Exceptions (anomalous coronary origin, aneurysm, etc.)
  • N: non-diagnostic study quality
  • P: Overall plaque burden assessment P1 Mild burden = calcium score 1-100
  • P2 Moderate burden = calcium score 101-300
  • P3 Severe burden = calcium score 301-1000
  • P4 Extensive burden = calcium score >1000

Calcium score in Agatston units:

  • 0: zero calcium score
  • 1-10: minimal calcium score
  • 11-100: low calcium score
  • 101-400: moderate calcium score
  • 400-1000: severe calcium score
  • > 1000: very severe calcium score

Differential diagnosis

Myocardial bridge