Coronary artery ulceration

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2]

An ulcerated lesion is defined as a cavity in the vessel wall with disruption of the intima and flow observed within the plaque cavity. Coronary artery ulceration is assessed visually using a well defined grading system. Grade 0 corresponds to no angiographic evidence of ulceration, grade 1 ulceration is present when the lesion contains a neck with contrast material dissecting under the plaque either proximally or distally, and grade 2 ulceration is present when there is distinct extravascular extravasation of contrast material with the appearance of a mushroom.

Grade 0: No angiographic evidence of ulceration

Shown below are an animated image and a static image depicting a normal RCA with no evidence of ulceration.

Grade 1: The lesion contains a neck with contrast material dissecting under the plaque either proximally or distally.

Grade 2: Distinct extravascular extravasation of contrast material with the appearance of a mushroom

Shown below are an animated image and a static image depicting grade 2 ulcerated lesion. Encircled in yellow in the image on the right is the ulcerated lesion which has a “mushroom” appearance.

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