In het Engels mogen ze het dan een tortuous lesion noemen, het kan niet worden vertaald met 'gekronkelde laesie' in het Nederlands.

De 'leasie', of de stenose, of het vaatletsel, bevindt zich op de binnenzijde van de vaatwand, al dan niet in een gekronkeld vat.
Die gekronkeldheid heeft wel invloed op de laesie, immers als het vat gekronkeld is en de laesie in dit gekronkelde deel ligt, volgt de leasie de gekronkelde vaatwand.

(Ernstige) gekronkeldheid is een van de factoren bij de indicatiestelling.


Thus, for the selection of the optimal revascularization strategy for patients with three vessel and/or left main stem disease there are three major requirements:
1. The conductance of an “all comer” (no exclusion criteria) study in such patients.
2. Consensus between the interventional cardiologist and the cardiothoracic surgeon for the treatment plan.
3. The quantification of the complexity of coronary artery disease, taking into account not only the number of significant lesions and their location, but also the complexity of each lesion independently.
The SYNTAX (SYNergy between PCI with TAXUS™ and Cardiac Surgery) study was organized as an all comer study for patients with significant lesions in the left main stem and/or the three epicardial coronary arteries.

The SYNTAX score has been developed for this study to prospectively characterise the coronary vasculature with respect to the number of lesions and their functional impact, location, and complexity.
Higher SYNTAX scores, indicative of more complex disease are hypothesized to represent a bigger therapeutic challenge and to have potentially worse prognosis.

Pre-existing classifications
The SYNTAX score has been developed based on the following:
1. The AHA classification of the coronary tree segments modified for the ARTS study
2. The Leaman score
3. The ACC/AHA lesions classification system
4. The total occlusion classification system
5. The Duke and ICPS classification systems for bifurcation lesions
6. Consultation of experts

Severe tortuosity:= One or more bends of 90° or more, or three or more bends of 45° to 90° proximal of the diseased segment.

Table 2. Lesions adverse characteristic scoring
Diameter reduction*
- Total occlusion --> x5
- Significant lesion (50-99%) --> x2
Total occlusion (TO)
- Age >3months or unknown --> +1
- Blunt stump --> +1
- Bridging --> +1
- First segment visible beyond --> TO +1/ per non-visible segment
- Side branch (SB) - Yes, SB <1.5mm** -->> +1
- Yes, both SB < & ≥ 1.5mm --> +1
Trifurcations
- 1 diseased segment --> +3
- 2 diseased segments --> +4
- 3 diseased segments --> +5
- 4 diseased segments --> +6
Bifurcations
- Type A, B, C --> +1
- Type D, E, F, G --> +2
- Angulation <70° --> +1
Aorto ostial stenosis --> +1
Severe tortuosity --> +2
Length > 20mm --> +1
Heavy calcification --> +2
Thrombus --> +1
“Diffuse disease”/small vessels --> +1/ per segment number

http://www.suc.org.uy/emcc2008/Curso_Imag_2008_archivos/Bibl...

Dit gaat over contra-indicaties voor het gebruik van een bepaalde katheter.
Maar het geeft gewoon aan dat gekronkeldheid specifieke eisen met zich meebrengt met betrekking tot de uitvoering van een PTCA.


CONTRA-INDICATIES:
• Gebruik in cerebrale vasculatuur
• Situaties met een redelijke kans op weefsel- of orgaanschade
• Vaatspasme
• Ernstige calcificatie
• Angiografisch bewijs van trombus
• Ernstig gekronkeld vat

http://www.volcanocorp.com/products/ifu-files/PV035online004...