Coronary angiography left coronary artery: Difference between revisions
Gerald Chi (talk | contribs) mNo edit summary |
Gerald Chi (talk | contribs) mNo edit summary |
||
| Line 3: | Line 3: | ||
==Overview== | ==Overview== | ||
The left main coronary artery gives rise to the left anterior descending artery and the left circumflex coronary artery. Complete visualization of these arteries and their branches requires care and rigor to ensure complete anatomical documentation. Often bifurcations and vessel foreshortening and overlap cause errors in stenosis estimation. There are no steadfast rules in which tomographic views are most useful. Generally, for circumflex and proximal epicardial visualization the caudal views are most useful. For LAD and LAD/diagonal bifurcation visualization the cranial views are most useful. Overall, if there is not a significant limitation on contrast utilization, standard 'around the world' angiography using a selection of the following angiographic views will document left coronary anatomy. | The left main coronary artery gives rise to the left anterior descending (LAD) artery and the left circumflex coronary (LCx) artery. Complete visualization of these arteries and their branches requires care and rigor to ensure complete anatomical documentation. Often bifurcations and vessel foreshortening and overlap cause errors in stenosis estimation. There are no steadfast rules in which tomographic views are most useful. Generally, for circumflex and proximal epicardial visualization, the caudal views are most useful. For LAD and LAD/diagonal bifurcation visualization, the cranial views are most useful. Overall, if there is not a significant limitation on contrast utilization, standard 'around the world' angiography using a selection of the following angiographic views will document left coronary anatomy. | ||
==How to Engage the | ==How to Engage the Left Coronary Artery== | ||
The left main coronary artery is typically cannulated in the 30° RAO position. Using the femoral arterial approach, a Judkins Left 4 (JL4) catheter is used to engage the left coronary artery. The JL catheter usually requires no manipulation other than a simple forward push by the operator. Variations in aortic root size may prevent selective engagement of the left main coronary artery and catheters of different sizes may be utilized accordingly. Variations in the location of ostium and orientation of left main stems may lead to difficult catheter engagement. For superiorly directed left main stems, a shorter Judkins catheter may be used, while inferiorly directed left main stems are engaged by a longer JL catheter or a left Amplatz catheter. If the ostium of the left main coronary artery has a posterior trajectory, a left Amplatz catheter may engage better. | |||
==Optimal Views of the | ==Optimal Views of the Left Coronary Artery== | ||
===RAO Caudal=== | ===RAO Caudal=== | ||
Revision as of 17:26, 4 September 2013
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
The left main coronary artery gives rise to the left anterior descending (LAD) artery and the left circumflex coronary (LCx) artery. Complete visualization of these arteries and their branches requires care and rigor to ensure complete anatomical documentation. Often bifurcations and vessel foreshortening and overlap cause errors in stenosis estimation. There are no steadfast rules in which tomographic views are most useful. Generally, for circumflex and proximal epicardial visualization, the caudal views are most useful. For LAD and LAD/diagonal bifurcation visualization, the cranial views are most useful. Overall, if there is not a significant limitation on contrast utilization, standard 'around the world' angiography using a selection of the following angiographic views will document left coronary anatomy.
How to Engage the Left Coronary Artery
The left main coronary artery is typically cannulated in the 30° RAO position. Using the femoral arterial approach, a Judkins Left 4 (JL4) catheter is used to engage the left coronary artery. The JL catheter usually requires no manipulation other than a simple forward push by the operator. Variations in aortic root size may prevent selective engagement of the left main coronary artery and catheters of different sizes may be utilized accordingly. Variations in the location of ostium and orientation of left main stems may lead to difficult catheter engagement. For superiorly directed left main stems, a shorter Judkins catheter may be used, while inferiorly directed left main stems are engaged by a longer JL catheter or a left Amplatz catheter. If the ostium of the left main coronary artery has a posterior trajectory, a left Amplatz catheter may engage better.