Coronary angiography right coronary artery
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
The right coronary artery (RCA) is a coronary artery with a single origin that bifurcates (branches) to supply the right ventricular free wall (the acute marginal branches) and the inferior wall of the left ventricle through the posterior descending artery and the posterolateral wall of the left ventricle via the right posterolateral branch. On coronary angiography, the RCA is easily recognizable as it appears like the letter C in the left anterior obliques (LAO) projection and appears like a letter L in the right anterior oblique (RAO) projection. There are three angiographic views of the RCA that are traditionally obtained to visualize teh proximal, mid and distal segments.
How to Engage the Right Coronary Artery
The Right Coronary Artery (RCA) is engaged in the 30o left anterior oblique (LAO) position. Using the femoral arterial approach, a Judkins Right 4 (JR4) catheter is traditionally used. The JR4 catheter is advanced into the body to make contact with the aortic valve. Next, the operator gently pulls the catheter out of the body about 2 cm while torquing the catheter clockwise. When the catheter faces to the left on the screen, it should be in or near the ostium of the right coronary artery.
Optimal Views of the Right Coronary Artery
The following sequence of views is obtained as the gantry is swung from the 30o position to the AP cranial position with cranial angulation to the RAO 30 position.
Proximal RCA
The proximal RCA including the ostium is best visualized in the LAO 30 view with no cranial or caudal angulation.
Bifurcation of the RCA
The bifurcation of the distal RCA where the right posterolateral artery and the posterior descending artery originate is best visualized using 30 o of cranial angulation and no right or left angulation (the anteroposterior (AP) 0 cranial 30o view).
Mid RCA
The middle RCA is best visualized in the straight right anterior oblique (RAO) 30 oview.
RCA LAO View
Initial angiographic imaging of the RCA in the LAO 30 projection gives the best view of significant ostial and proximal RCA disease.
RCA RAO View
The mid RCA is best visualized in the straight RAO 30 position.
RCA AP 0 Cranial 30 View
The bifurcation of the distal RCA and rPDA is best seen in the AP 0 Cranial 30 view with a small breath in.