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 near the right cusp of the aortic valve 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 the proximal, mid and distal segments.

How to Engage the Right Coronary Artery

The Right Coronary Artery (RCA) is engaged in the 30^o left anterior oblique (LAO) position. Using the femoral arterial approach, a Judkins Right 4 (JR4) catheter is traditionally used to engage the right coronary artery. 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. Other catheters that can be used to engage the right coronary artery include that Amplatz Right (AR1), and Amplatz Left (AL2, and AL3) catheters. If the origin of the right coronary artery has an upward trajectory, an internal mammary artery catheter may engage better.

Optimal Views of the Right Coronary Artery

The following sequence of 3 traditional views is obtained as the gantry is swung from the 30^o LAO position to the AP cranial position to the 30^o RAO position.

Proximal RCA

The proximal RCA including the ostium is best visualized in the 30^o LAO view with no cranial or caudal angulation.

File:RCA LAO Cranial.png

RCA LAO 30 CAU

Bifurcation of the RCA

The camera is next swung cranially to 15^o to 20^o and the LAO angulation is minimized to 5^o-10^o. This view optimizes the bifurcation of the distal RCA where the right posterolateral artery and the posterior descending artery branch. The patient should take a deep breath and hold it during the injection to optimize the view.

Mid RCA

The middle RCA is best visualized in the straight right anterior oblique (RAO) 30 ^oview.

References

v t e Coronary Angiography
Coronary Anatomy	Normal coronary anatomy • Anomalous origins of coronary arteries (Left coronary artery • Right coronary artery) • Congenital abnormalities of coronary arteries • Coronary artery segments • Cinefilm frame speed • Coronary artery dominance (Left dominance • Right dominance • Co-dominance)
TIMI Flow Grade	TIMI flow grade 0 • TIMI flow grade 1 • TIMI flow grade 2 • TIMI flow grade 3
TIMI Frame Count	TFC for SVG • TIMI Myocardial Frame Count • Washout TIMI Frame Count
TIMI Myocardial Perfusion Grade	TIMI MPG 0 • TIMI MPG 1 • TIMI MPG 2 • TIMI MPG 3
Thrombus Grading	Thrombus Grade 0 • Thrombus Grade 1 • Thrombus Grade 2 • Thrombus Grade 3 • Thrombus Grade 4 • Thrombus Grade 5 • Thrombus Grade 6
Lesion Complexity	Type A • Type B₁ • Type B₂ • Type C
Dissection Classification	Type A • Type B • Type C • Type D • Type E • Type F
Coronary Collaterals	Grade 0 • Grade 1 • Grade 2 • Grade 3 • Rentrop and Cohen’s Collateral Classification
Lesion Morphology	Myocardial bridge •Definitions of Preprocedural Lesion Morphology • Luminal irregularities • Disease extent • Arterial foreshortening • Infarct related artery (Culprit lesion) • Reocclusion • Restenosis • Degenerated saphenous vein graft • Coronary artery fistula
Angiographic complications	Distal embolization • Coronary spasm • Abrupt closure • Side branch loss • Slow flow • No-reflow • Pulsatile flow • Flow deceleration • Ectasia • Intimal flap • Staining •
Performing Coronary Angiography	Patient preparation • Catheter selection • Standard angiographic views • High risk groups • Patients with special need • Access site closure (Manual compression • Assisted compression • Closure devices) •
Quantitative Coronary Angiography (QCA)	Minimal lumen diameter • Percent stenosis • Reference diameter • Lesion length • Residual stenosis • Average reference segment diameter • Plaque area • Plaque volume •
Contrast Media	High-osmolar contrast media • Iso-osmolar contrast media • Low-osmolar contrast media
Left Ventriculography & Aortography	Ejection fraction • Aortography • Quantitative Left Ventricular Analysis (LAO projection • RAO projection • LVA) • Left Ventricular Wall Motion Analysis (Normokinesia • Hypokinesia • Akinesia • Dyskinesia • Aneurysm) • Evaluation of mitral regurgitation • Evaluation of aortic regurgitation
Right Heart Catheterization	Pressure waveforms (Right atrial pressure • Rirght ventricular pressure • Pulmonary artery pressure • Pulmonary artery wedge-pressure) • Endomyocardial biopsy
Complications	Access site complications • Dumping • Contrast hypersensitivity • Contrast induced nephropathy • Hypotension • Hypertension • Dissection • Vessel perforation • Acute myocardial infarction • Ventricular fibrillation • Cardiac arrest • Stroke • ASD • VSD • Pulmonary emboli • Myocardial rupture • Peripheral arterial emboli • Radiation injury