Prevalence of anatomical variants and coronary anomalies in 543 consecutive patients studied with 64-slice CT coronary angiography

Abstract

The aim of our study was to assess the prevalence of variants and anomalies of the coronary artery tree in patients who underwent 64-slice computed tomography coronary angiography (CT-CA) for suspected or known coronary artery disease. A total of 543 patients (389 male, mean age 60.5±10.9) were reviewed for coronary artery variants and anomalies including post-processing tools. The majority of segments were identified according to the American Heart Association scheme. The coronary dominance pattern results were: right, 86.6%; left, 9.2%; balanced, 4.2%. The left main coronary artery had a mean length of 112±55 mm. The intermediate branch was present in the 21.9%. A variable number of diagonals (one, 25%; two, 49.7%; more than two, 24%; none, 1.3%) and marginals (one, 35.2%; two, 46.2%; more than two, 18%; none, 0.6%) was visualized. Furthermore, CT-CA may visualize smaller branches such as the conus branch artery (98%), the sinus node artery (91.6%), and the septal branches (93%). Single or associated coronary anomalies occurred in 18.4% of the patients, with the following distribution: 43 anomalies of origin and course, 68 intrinsic anomalies (59 myocardial bridging, nine aneurisms), three fistulas. In conclusion, 64-slice CT-CA provides optimal visualization of the variable and complex anatomy of coronary arteries because of the improved isotropic spatial resolution and flexible post-processing tool.

Right coronary artery anatomy: anatomical and morphometric analysis

“…Equally, we noted a RCA short finishing as subsequent branch of the right ventricle in the 8.6% similar to other works [1][2][3]. We consider that a vascular compensation is inferred when RCA finish in short branches on the diaphragmatic face of the hearth and additional supplies Saremi et al [8] and Cademartiri et al [34]. Futami [35] also reported a double origin in 23% of Japanese population.…”

Coronary artery anomalies detected by MSCT-coronary angiography in the adult

“…25 Recently Cademartiri and colleagues reported a prevalence for ACAOS of 1.5% as detected by MSCT-CA in a series of 543 patients. 26 According to the authors, the number of detected CAAs in this study was positively influenced by selection bias. More than 10% of their study population were referred for MSCT-CA after suspicion of a CAA by means of invasive coronary angiography.…”

Common origin of the coronary arteries: A rare coronary artery anomaly

“…2 Anomalies involving abnormal origin of the coronary arteries are clinically important and are commonly associated with some form of congenital heart disease, and the presence of coronary artery anomalies in the absence of any other congenital heart defect is considered rare. The overall incidence of isolated coronary artery anomalies in various studies ranges from 5.6% in a study by Angelini 1 (using conventional catheter angiography) to an incidence of approximately 18.5% in a study by Cademartiri et al 3 (based on 64-slice coronary CT angiography). Anomalies of origin and course of coronary arteries are rarer still and were seen in 0.95% of test subjects undergoing conventional catheter angiography in an Indian study 4 and in up to 1.5% of patients in an European study.…”

“…Anomalies of origin and course of coronary arteries are rarer still and were seen in 0.95% of test subjects undergoing conventional catheter angiography in an Indian study 4 and in up to 1.5% of patients in an European study. 3 Cademartiri concluded that coronary CT angiography is superior to catheter angiography in the diagnosis of an anomaly. 3 Common origin of left coronary artery and RCA from right coronary sinus is one of the rarest anomalies with an incidence rate of around 0.15%, 3 and we have not come across any cases in literature of an absent left main artery with LCx and LAD sharing a common origin with RCA from right coronary sinus.…”

“…3 Cademartiri concluded that coronary CT angiography is superior to catheter angiography in the diagnosis of an anomaly. 3 Common origin of left coronary artery and RCA from right coronary sinus is one of the rarest anomalies with an incidence rate of around 0.15%, 3 and we have not come across any cases in literature of an absent left main artery with LCx and LAD sharing a common origin with RCA from right coronary sinus.…”