Cross-sectional area measurement of the coronary arteries using CT angiography at the level of the bifurcation: is there a relationship?

Abstract

C oronary artery disease is the leading cause of death worldwide. Thus, coronary artery imaging is one of the most commonly used diagnostic methods. Recently, coronary computed tomography angiography (CCTA) has become another widely used method in coronary artery imaging since it is a noninvasive technique that is easy to perform (1, 2).One of the major advantages of CCTA is that it allows for the measurement of not only two-dimensional diameters but also cross-sectional areas of the vascular structures. Thus, it is possible to calculate the degree of narrowing caused by atherosclerotic plaques in case of obstruction. It is also possible to predict the symptoms that may arise in a patient in relation to the obstruction and determine the treatment that can be performed using CT angiography.Atherosclerotic plaques are commonly seen adjacent to vascular bifurcations (3, 4). Left main coronary artery (LMCA) length is variable, and it is shorter in comparison with other main coronary arteries. Therefore, atherosclerotic plaques can occupy the whole vessel in some cases. In such cases, it is difficult to determine the degree of narrowing caused by the plaque since it is not possible to understand the reference artery diameter. Similarly, normal dimensions of the arteries might not be understood in cases of plaque build-up that occupy the long segment starting from the left anterior descending artery (LAD) and circumflex artery (CX) origin. Recently developed multidetector computed tomography (MDCT) technology provides valuable information in terms of understanding three-dimensional anatomy of coronary bifurcation and measuring the angle and vessel cross-sectional area (5, 6). This information is considerably important for the diagnosis and treatment of bifurcation lesions. 454From the Department of Radiology (S.V.), Mevki Military Hospital, Ankara, Turkey; the Departments of Radiology (E.Ö.  drersinozturk@gmail.com, K.K., M.S.) and Cardiology (U.K., E.K.), GATA Haydarpaşa Training Hospital, İstanbul, Turkey. PURPOSEOur aim was to determine whether there is a correlation between cross-sectional areas of the left main coronary artery (LMCA), left anterior descending artery (LAD), and circumflex artery (CX) in normal cases using coronary CT angiography. METHODExaminations of 180 patients (119 men and 61 women) were selected among 2248 consecutive coronary CT angiography studies. Cross-sectional areas of LMCA, LAD, and CX were measured at the level of bifurcation. Correlation between age, height, and body mass index and coronary artery cross-sectional areas was investigated and possibility of formulating a correlation between the cross-sectional areas of LMCA, LAD, and CX was explored. RESULTSMean cross-sectional areas of LMCA, LAD, and CX were found as 17.4±3.9 mm 2 , 12.5±3.1 mm 2 , and 10.5±3.0 mm 2 , respectively. While cross-sectional areas of LMCA and LAD were significantly larger in men, no significant difference was found between the sectional areas of CX in men and women. A multiple regression analysis was cond...

A coronary computed tomography angiography study on anatomical characteristics of the diagonal branch of anterior interventricular artery

“…The differences in the LAD and LCX diameters between males and females in the population without RIs have been compared in domestic and foreign studies. Verim et al [10] measured the lumen area at the proximal segments of the branch vessels of the LCA in 108 patients and found that the LAD lumen area in males was significantly larger than in females; no gender difference was observed in the LCX lumen area. Liu et al [8] compared the lumen intraluminal diameter of proximal vessels between males and females at the left main bifurcation area of patients with predominant right coronary arteries and without RIs and found significant differences in the LAD and LCX intraluminal diameters (larger in males than in females).…”

Remodelled multiple linear regression equation for stent size calculations of left anterior descending artery (LAD-proximal) dimensions with single vessel disease

“…Pearson's correlation coefficient of LAD was 0.623**(mm) and LCx was 0.428**(mm) respectively [17]. A strong correlation between the cross-sectional areas of LMCA with LAD and LCx was assessed (r = 0.779, p < 0.001 and r = 0.678, P < 0.001, respectively) at the bifurcation level, and a regression equation was formulated to predict LMCA dimensions (LMCA= 3.870 + 0.718 × LAD + 0.434 × LCx) [18]. But the present study reveals that the equation cannot be unique for the LMCA as the cases for isolated left main lesions are limited and risk levels are more in those cases.…”