CT angiography analysis of dual left anterior descending artery with origin of the long left anterior descending artery from right coronary sinus or right coronary artery
Liu Xiaolong, Wang Xiaoqiang, Sun Zhanguo, Shao Kai, Chen Yueqin, Li Kaihua, Wang Yanhui, Wang Peijie
Department of Radiology, Affiliated Hospital of Jining Medical University, Jining 272029, China
Abstract：Objective A study was conducted to investigate the CT angiography (CTA) anatomical features and clinical significance of the dual left anterior descending artery (LAD) anomaly with long LAD originating from the right coronary sinus (RCS) or right coronary artery (RCA). Methods A cross-sectional study was conducted. Data of 25 patients, namely, 16 males and 9 females, aged 29-87 years old (mean, [59.0±15.2] years old) with dual LAD anomaly with long LAD originating from RCS or RCA, were retrospectively collected from among 79 617 patients who underwent coronary CTA (CCTA) in the Affiliated Hospital of Jining Medical University from January 2015 to January 2022. According to the course of the long LAD, cases were divided into pre-pulmonic (pre-LAD groups, n=12) and sub-pulmonic (sub-LAD groups, n=13). Another 30 cases without coronary artery variants on CCTA examination were included as the control group. This control group included 17 males and 13 females, aged 34-76 years old (mean, [59.6±11.6] years old). Observation indexes were as follows: (1) to measure and compare the differences in the full length and the beginning segment diameter of the short and the long LADs and to compare the differences in age, sex, LAD length (full length and anterior segment of the anterior interventricular groove), and tube diameter (beginning, middle, and distal segments) in the pre-LAD, sub-LAD, and control groups; (2) The differences in long LAD origin, diagonal branch, septal branch, and right conal branch were compared between the pre-LAD and sub-LAD groups; and (3) to assess the presence of coronary plaque and luminal stenosis of pre-LAD and sub-LAD groups and to compare the differences in the overall coronary plaque incidence between patients in the two groups, the difference in plaque incidence between the pre-LAD and the sub-LAD, and between the long and the short LADs. Results The incidence of long LAD originating from the RCS/RCA variant was 0.31‰ (25/79 617), of which 0.20‰ (16/79 617) originated from the RCS, and 0.11‰ (9/79 617) originated from the proximal segment of RCA. (1) The full lengths of long LAD and short LAD were (137.5±23.4) mm and (47.6±12.3) mm, respectively, and the difference was statistically significant (t=17.01, P<0.001). The difference in the diameters of the two starting segments were not statistically significant (P>0.05). No statistically significant differences were found in the age and sex of patients in the control, pre-LAD, and sub-LAD groups (all P values >0.05). The full length of the LAD in the control group ([149.0±17.6] mm) was greater than that in the sub-LAD group ([129.2±21.2] mm). The segment before the anterior interventricular groove of the pre-LAD group ([90.8±15.7] mm) was longer than those of the sub-LAD group ([48.1±8.4] mm) and the control group ([21.6±5.2] mm). The diameter of the beginning segment of the LAD in the control group was greater than those of the pre-LAD and the sub-LAD groups. The middle segment diameters of the pre-LAD and the LAD in control group were greater than that of the sub-LAD group. The diameters of the distal segment of the sub-LAD and the LAD in the control group were greater than that of the pre-LAD group. These differences were statistically significant (all P values <0.05). The diameter of LAD from proximal to distal segment was gradually reduced in both the pre-LAD and control groups. However, the diameter of the distal segment of the sub-LAD was larger than that of the middle segment with statistically significant difference (t=-3.14, P=0.004). (2) The differences in origin location of the long LAD, and presence of diagonal branches between the pre-LAD and the sub-LAD groups were not statistically significant (all P values >0.05). Septal branches were shown in three pre-LADs (3/12) and 11 sub-LADs (11/13), and these had a statistically significant difference (P=0.005). The right conal branch originated from the long LAD in the pre-LAD group, from the proximal RCA or RCS in the sub-LAD group, and this difference was statistically significant (P<0.001). (3) Neither the overall coronary plaque incidence between patients in the pre-LAD group and sub-LAD group (8/12 versus 8/13) nor the plaque incidence of the long LAD between both groups (2/12 versus 0/13) had a statistically significant difference (all P values >0.05). In these two groups, two long LADs (8%, 2/25) and 12 short LADs (48%, 12/25) had plaques, and the differences were statistically significant (χ2=9.92, P=0.002). Conclusion The anatomical differences between the dual LAD anomaly with long LAD originating from the right RCS or RCA and the normal LAD are large. A comprehensive assessment of the origin, course, branches, important anatomical relationships, and lumen conditions of long LAD and short LAD in the dual LAD variant is clinically important for the interpretation of related cardiovascular symptoms and the development of surgical plans.
刘晓龙, 王小强, 孙占国, 邵凯, 陈月芹, 李开华, 王彦辉, 王培洁. 左前降支长支起自右冠状动脉或右冠状窦的双前降支变异的CT血管成像解剖学特征分析[J]. 中华解剖与临床杂志, 2023, 28(2): 75-82.
Liu Xiaolong, Wang Xiaoqiang, Sun Zhanguo, Shao Kai, Chen Yueqin, Li Kaihua, Wang Yanhui, Wang Peijie. CT angiography analysis of dual left anterior descending artery with origin of the long left anterior descending artery from right coronary sinus or right coronary artery. Chinese Journal of Anatomy and Clinics, 2023, 28(2): 75-82.
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