The eccentric lumenology

Coronary angiography has a poor predictive value for the detection of eccentric plaque morphology. Many reports have demonstrated discordance between the angiographic classification and the intravascular ultrasound (IVUS) classification. Although eccentricity is usually considered a dichotomous character, more than two-thirds of all coronary stenosis have some degree of eccentricity. The American College of Cardiology/American Heart Association (ACC/AHA) Task force included lesion eccentricity as a risk factor for moderate procedural success (60-85%) and moderate complications (type B). Although lesion eccentricity has been implicated as a risk factor for reduced short-term procedural results, current available data does not support the adverse impact of eccentricity on procedural success or restenosis. The present article reviews the incidence and the various clinical scenarios known to be associated with the eccentric lumenogram and the impact of coronary artery remodeling contributing to misinterpretation of disease eccentricity. Various therapeutic modalities with reference to eccentric lesions are also considered.