Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2005 Jul;91(7):968-76.
doi: 10.1136/hrt.2005.063107.

Coronary angiography in the angioplasty era: projections with a meaning

Carlo Di Mario  1 , Nilesh Sutaria
Affiliations
Review

Coronary angiography in the angioplasty era: projections with a meaning

Carlo Di Mario et al. Heart. 2005 Jul.
No abstract available

PubMed Disclaimer

Figures

Figure 1
Figure 1
(A) Left anterior oblique, 30° caudal. The image is clearly inadequate for visualising the stenosis at the bifurcation of the mid left anterior descending coronary artery (LAD) and second diagonal branch. Note that the image optimally displays the bifurcation of the LAD and left circumflex, but the shaft of the left main stem is foreshortened and the left main ostium is partially hidden by the coronary sinus. (B) 10° right anterior, 42° cranial view. The image optimally elongates the proximal and mid segments of the LAD and offers the best working projection for treatment of the bifurcation lesion. Note the improved elongation of the left main shaft and optimal delineation of the left main ostium while at the left main bifurcation the two branches are completely superimposed. (C) 40° left anterior oblique, 35° cranial view. Despite the obvious foreshortening and superimposition of the sinus of Valsalva on the proximal LAD, this image offers the best view of the stenosis distal to the bifurcation of the mid LAD (arrow).
Figure 2
Figure 2
(A) Repeated attempts at cannulating the right coronary artery were unsuccessful and failed to visualise the ostium even with a large injection through the right Judkins catheter low in the right coronary sinus. An aortogram is performed in a 60° left anterior oblique view. The high posterior origin of the right coronary artery (arrows) is partially delineated facilitating the subsequent catheter selection. (B) A 5 French multipurpose catheter is used to cannulate selectively the right coronary artery in the same view, showing a severe stenosis of the mid segment (arrow).
Figure 3
Figure 3
(A) 15° right anterior oblique, 30° caudal view. The improved fluoroscopic quality, smaller respiratory excursion, and reduced operator irradiation makes this view the preferred working projection for angioplasty of this lesion of intermediate severity of the distal left main/ostial LAD (arrow). (B) 45° left anterior oblique, 35° caudal view (“spider”). This view offers the greatest separation of LAD, intermediate, and left circumflex arteries. (C, D) As always, in the case of lesions of intermediate severity, a functional assessment is performed using a RADI pressure wire. After 86 μg of adenosine a fractional flow reserve of 0.89 is recorded in the left circumflex artery (C), reflecting the severity of the distal left main stenosis, and of 0.82 in the LAD (D), reflecting the severity of both the left main and ostial LAD stenosis. No intervention is required.
Figure 4
Figure 4
(A) 50° left anterior oblique view showing a 50% stenosis of the second segment of the right coronary artery (arrow). (B) 30° right anterior oblique view offering a complementary assessment of the severity of this eccentric lesion. Note that in this view the long posterior descending artery (PDA) is also well visualised at the bottom of the image with all septal branches pointing upwards. (C) 30° cranial anteroposterior view. Although this view conceals the stenosis of the mid segment of the right coronary artery, it offers excellent visualisation of the ostium of the right coronary, of the bifurcation of the PDA, and of the posterior left ventricular branch which, in this case, has a subocclusive stenosis (arrow).
Figure 5
Figure 5
(A) 10° right anterior 30° caudal view. Injection of the left coronary artery shows a long left main stem with no visible circumflex and a moderate restenosis of the mid segment of the LAD. (B) In the same view contrast is injected simultaneously through the right and the left coronary arteries showing well developed collaterals from the right coronary to the mid distal left circumflex, identifying the site of origin of the circumflex and allowing measurement of the short segment of occlusion. (C) Final result after angioplasty in the same view showing complete recanalisation of the circumflex artery using a 3.5 mm drug eluting stent.
Figure 6
Figure 6
Angiographic result following an injection of 25 ml of contrast, injected at 18 ml/s, with a pigtail catheter positioned immediately above the renal artery origin in an 8° left anterior oblique view. This identified a severe ostial stenosis of the right renal artery (arrow). This additional information allowed a more complete treatment of this 76 year old patient undergoing coronary angiography because of unstable angina but with a history of hypertension refractory to treatment, raised creatinine, and recurrent episodes of pulmonary oedema.
See this image and copyright information in PMC

References

    1. British Cardiac Intervention Society. British Cardiac Intervention Society audit data 2003. London: BCIS, 2003.
    1. Spacek R, Widimsky P, Straka Z, et al. Value of first day angiography/angioloasty in evolving non-ST segment elevation myocardial infarction: an open multicenter randomised trial. The VINO study. Eur Heart J 2002;23:230–8. - PubMed
    1. Kiemeneij F, Laarman G. Transradial artery coronary angioplasty. Am Heart J 1995;129:1–8. - PubMed
    1. Ikari Y, Ochial M, Hangaishi M, et al. Novel guide catheter for left coronary intervention via a right upper limb approach. Cathet Cardiovasc Diagn 1998;44:244–7. - PubMed
    1. Angelini P, Velasco JA, Flamm S. Coronary anomalies: incidence, pathophysiology, and clinical relevance. Circulation 2002;105:2449–54. - PubMed

MeSH terms