scholarly journals Site-specific Phenotype of Atherosclerotic Lesions According to Their Location Within the Coronary Tree – a CCTA-based Study of Vulnerable Plaques

2021 ◽  
Vol 7 (2) ◽  
pp. 39-46
Author(s):  
Diana Opincariu ◽  
Nora Rat ◽  
Andras Mester ◽  
Roxana Hodas ◽  
Daniel Cernica ◽  
...  
Keyword(s):  
Chest Pain ◽  
Coronary Artery ◽  
Right Coronary Artery ◽  
Circumflex Artery ◽  
Cross Sectional ◽  
Site Specific ◽  
Left Anterior Descending Artery ◽  
Atherosclerotic Lesions ◽  
Vulnerable Plaques ◽  
The Right

Abstract Background: The evaluation of site-specific phenotype according to the topographic location of atherosclerotic lesions within the coronary tree has not been studied so far. The present study is based on the premise that the location of coronary plaques can influence their composition and degree of vulnerability. Aim: To evaluate different phenotypes of vulnerable coronary plaques across the three major coronary arteries in terms of composition, morphology, and degree of vulnerability, in patients with chest pain and low-to-intermediate probability of coronary artery disease, using coronary computed tomography angiography (CCTA) and a complex plaque analysis. Material and methods: This was a cross-sectional study on 75 subjects undergoing CCTA for chest pain, who presented at least one vulnerable coronary plaque (VP), defined as the presence of ≥1 CT vulnerability marker (low attenuation plaque, napkin-ring sign, spotty calcifications, positive remodeling). The study included per plaque analysis of 90 vulnerable coronary lesions identified in various locations within the coronary tree as follows: n = 30 VPs in the left anterior descending artery (LAD), n = 30 VPs in the circumflex artery (CXA), and n = 30 VPs in the right coronary artery (RCA). Results: The RCA exhibited significantly longer VPs (p = 0.001), with the largest volume (p = 0.0007) compared to those arising from the LAD and CXA. Vulnerable plaques located in the LAD exhibited a significantly more calcified phenotype (calcified volume: LAD – 44.07 ± 63.90 mm3 vs. CXA – 12.40 ± 19.65 mm3 vs. RCA – 33.69 ± 34.38 mm3, p = 0.002). Plaques from the RCA presented a more non-calcified phenotype, with the largest non-calcified (p = 0.002), lipid rich (p = 0.0005), and fibrotic volumes (p = 0.003). Low-attenuation plaques were most frequent in the RCA (p = 0.0009), while the highest vulnerability degree was present in lesions located in the LAD, which presented the highest number of vulnerability markers per plaque (p = 0.01). Conclusions: Vulnerable plaques arising from the right coronary artery are longer, more vo-luminous and with larger lipid and non-calcified content, whereas those located in the left anterior descending artery present a higher volume of calcium, but also a higher degree of vulnerability. The least vulnerable lesions were present in the circumflex artery.

Coronariaeredési anomáliák kardio-CT-vizsgálatok során

2020 ◽  
Vol 161 (47) ◽  
pp. 1995-1999
Author(s):  
László Barna ◽  
Zsuzsanna Takács-Szabó ◽  
László Kostyál
Keyword(s):  
Computed Tomography ◽  
Chest Pain ◽  
Coronary Artery ◽  
Right Coronary Artery ◽  
Sinus Of Valsalva ◽  
Coronary Anomalies ◽  
Coronary Computed Tomography ◽  
Left Circumflex Artery ◽  
The Right ◽  
Left Sinus Of Valsalva

Összefoglaló. Bevezetés: Congenitalis coronariaanomáliának tekintik azokat a coronariamorfológiai rendellenességeket, melyek 1%-nál kisebb gyakorisággal fordulnak elő. Többségük nem jár tünettel, olykor azonban okozhatnak mellkasi fájdalmat, eszméletvesztést, és hirtelen halálhoz is vezethetnek. A coronariaanomáliák gyakoriságáról Magyarországon eddig csak invazív koronarográfiás adatok alapján jelent meg közlemény. Célkitűzés: Jelen vizsgálatunkban a coronariák eredési rendellenességeinek gyakoriságát mértük fel intézetünk coronaria-komputertomográfiás angiográfián átesett betegeinél. Módszer: A coronaria-komputertomográfiás vizsgálatra került betegek felvételeinek értékelésekor rögzítettük a coronariaanomália jelenlétét. A vizsgálat indikációja általában mellkasi fájdalom volt. 128 szeletes berendezést használtunk, a vizsgálatok során részben retrospektív, részben prospektív EKG-kapuzást alkalmaztunk. Eredmények: 1751 beteg komputertomográfiás angiográfiás felvételeit elemeztük. A betegek között a férfiak aránya 38,4%, a vizsgálatra kerülők életkorának átlaga pedig 58,07 ± 11,07 év volt. Eredési anomáliát 1,83%-ban találtunk, ezen belül a leggyakoribb volt a körbefutó ág (ramus circumflexus) és az elülső leszálló ág különálló eredése a bal Valsalva-sinusból (1%). A további rendellenességek a következők voltak: a jobb coronaria eredése magasan az aortából (0,34%), ramus circumflexus a jobb sinusból vagy a jobb coronariából (0,34%), jobb coronaria a bal Valsalva-sinusból (0,057%), elülső leszálló ág részben a bal Valsalva-sinusból a circumflexustól külön, részben a jobb coronariából (kettős elülső leszálló ág, 0,057%). Következtetés: Mindössze 0,057%-ban fordult elő potenciálisan tünetet okozó coronariaeredési rendellenesség (a bal sinusból eredő jobb coronaria). A komputertomográfiás angiográfia segítségével a coronariaeredés helye pontosan megállapítható, tisztázható az ér lefutása és ennek során viszonya a környező struktúrákhoz. Orv Hetil. 2020; 161(47): 1995–1999. Summary. Introduction: Congenital coronary artery anomaly is defined as a coronary morphology which occurs in less than 1% of the cases. Usually these anomalies do not result in symptoms but sometimes they can cause chest pain, syncope and sudden death. In Hungary, the prevalence of these abnormalities was published only from data of invasive coronary angiography. Objective: In this study, we evaluated the prevalence of the anomalies of coronary origin in the patients of our institution undergoing coronary computed tomography. Method: While reading the computed tomography angiograms of our patients, we registered the presence of coronary anomalies. In most of the cases, the indication of the coronary computed tomography was chest pain. A scanner with 128 detectors was used, scans were performed partly with prospective, partly with retrospective ECG gating. Results: We assessed 1751 patients. The ratio of males was 38.4%, while the average age of patients 58.07 ± 11.07 years. Anomaly of coronary origin was present in 1.83% of our patients, with the separate origin of left anterior descending and left circumflex artery being the most frequent (1%) among them. Other anomalies were as follows: high take-off of the right coronary artery from the ascending aorta (0.34%), left circumflex arising from the right sinus of Valsalva or from the right coronary (0.34%), right coronary artery from the left sinus of Valsalva (0.057%), left anterior descending arising partly from the left sinus of Valsalva, apart from the left circumflex, partly from the right coronary (dual left anterior descending artery, 0.057%). Conclusion: The prevalence of potentially symptomatic coronary anomalies was only 0.057% in our series (right coronary from the left sinus of Valsalva). The computed tomography angiography can precisely define the origin of the coronary artery, depict its run-off and its relationship to the neighbouring structures. Orv Hetil. 2020; 161(47): 1995–1999.

scholarly journals Superdominant Right Coronary Artery with Absent Left Coronary Artery and Left Circumflex Artery with Anomalous Left Anterior Descending Artery

2022 ◽  
Author(s):  
Bhavneet Singh ◽  
Rekha Gupta ◽  
Sreenivas Reddy
Keyword(s):  
Coronary Artery ◽  
Right Coronary Artery ◽  
Coronary Sinus ◽  
Left Coronary Artery ◽  
Therapeutic Modality ◽  
Single Coronary Artery ◽  
Circumflex Artery ◽  
Left Circumflex Artery ◽  
Single Vessel ◽  
Left Anterior Descending Artery

AbstractThe occurrence of super-dominant “single coronary artery” is an extremely rare and seldom reported phenomenon. The heart is dependent on a single vessel which makes its occlusion, if present, catastrophic. Here, the authors present an extremely rare combination of superdominant right coronary artery coexisting with absent left coronary artery and left circumflex artery with abnormal origin of left anterior descending artery from right coronary sinus. Precise morphological and physiological knowledge and evaluation of these anomalies is a must for opting the best available therapeutic modality and better prognosis.

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