Small vessel coronary artery disease: How small can we go with myocardial revascularization?

Figures

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  Figure 1. Example of small vessel disease amenable to percutaneous coronary intervention (RAO 30°; CRA°). A. Acute occlusion of small (1.5 mm) diagonal branch (arrow); B. Final angiographic result; percutaneous coronary intervention with 2.0 × 18 mm everolimus-eluting stent implantation in the proximal part of the vessel with slight oversize (left arrow); the image shows considerable length and extensive area supplied by the initially occluded vessel (right arrow).

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  Figure 2. Example of diffuse small coronary artery atherosclerosis suitable for medical management (LAO 15°, CRA 30°); widespread significant lesions located predominantly in the peripheral and narrow parts of the coronary vessels (arrows).

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  Figure 3. Classification of coronary arteries and the management of hemodynamically significant lesions depending on vessel diameter; SVD — small vessel disease; ACS — acute coronary syndrome; CCS — chronic coronary syndrome; FFR — fractional flow reserve; iFR — instantaneous wave-free ratio; BMT — best medical therapy; POBA — plain old balloon angioplasty; DEB — drug-eluting balloon; DES — drug-eluting stent; TIMI — Thrombolysis in Myocardial Infarction score.