Interventional Approach in Small Vessel, Diffuse, and Tortuous Coronary Artery Disease

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.