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
. 2022 Sep;100(3):378-386.
doi: 10.1002/ccd.30322. Epub 2022 Jul 12.

Angiographic predictors of aberrant circumflex artery during cardiac catheterization

Andreas S Triantafyllis  1   2   3 , Lokien X van Nunen  2 , Pierluizi Lesizza  3 , Efstathios D Pagourelias  3 , Aimilianos Kalogeris  1 , Sjoerd Bouwmeester  2 , Pavlos Tsinivizov  1 , Nestoras Kontogiannis  1 , Andreas Giannakopoulos  1 , Leonidas E Poulimenos  1 , Johan Bennett  3 , Koen Teeuwen  2 , Konstantinos Kyfnidis  1 , Walter Desmet  3 , Pim A L Tonino  2 , Keir McCutcheon  3
Affiliations

Angiographic predictors of aberrant circumflex artery during cardiac catheterization

Andreas S Triantafyllis et al. Catheter Cardiovasc Interv. 2022 Sep.

Abstract

Objectives: To identify angiographic predictors of aberrant left circumflex artery (LCx) by comparing left main (LM) length and bifurcation angle between patients with aberrant LCx and normal anatomy.

Background: Failure to recognize aberrant LCx during a cardiac catheterization may hamper correct diagnosis, delay intervention in acute coronary syndromes, and result in increased contrast volume, radiation exposure, and infarct size.

Methods: We retrospectively analyzed angiograms of aberrant LCx patients and normal anatomy matched controls, in three-participating centers. LM-length, bifurcation angle between the left anterior descending (LAD) and the first non-LAD branch of the LM, and procedural data were compared.

Results: Between 2003 and 2020, 136 patients with aberrant LCx and 135 controls were identified. More catheters (2.4 ± 0.6 vs. 2.2 ± 0.9, p = 0.009), larger contrast volumes (169 ± 94 ml vs. 129 ± 68 ml, p < 0.0005), and prolonged fluoroscopy time (652.9 ± 623.7 s vs. 393.1 ± 332.1 s, p < 0.0005), were required in the aberrant LCx-group compared with controls. Patients with aberrant LCx had a longer LM-length and a more acute bifurcation angle, both in caudal and cranial views, compared with controls (24.7 ± 8.1 vs. 10.8 ± 4.5 mm, p < 0.0005 and 26.7 ± 7.4 vs. 12 ± 5.5 mm, p < 0.0005, respectively, and 45.2° ± 12° vs. 88.8° ± 23°, p < 0.0005 and 51.9° ± 21° vs. 68.2° ± 28.3°, p < 0.0005, respectively). In ROC analysis, LM-length showed the best diagnostic accuracy for detecting aberrant LCx. In multiple logistic regression analysis, a cranially measured LM-length > 17.7 mm was associated with a 5.3 times greater probability of predicting aberrant LCx [95% CI (3.4-8.1), p < 0.0001].

Conclusions: Our study suggests that a long LM-length and an acute bifurcation angle can indicate the presence of aberrant LCx. We present a practical algorithm for its rapid identification.

Keywords: aberrant circumflex; bifurcation angle; contrast volume; coronary; fluoroscopy time; left main length.

PubMed Disclaimer

References

REFERENCES

    1. Angelini P. Coronary artery anomalies: an entity in search of an identity. Circulation. 2007;115(10):1296-1305.
    1. Barriales-Villa R, Morís C, Sanmartín JC, Fernández E, Pajín F, Ruiz Nodar JM. Registro de anomalías congénitas de las arterias coronarias con origen en el seno de Valsalva contralateral en 13 hospitales españoles (RACES) [anomalous coronary arteries originating in the contralateral sinus of Valsalva: registry of thirteen Spanish hospitals (RACES)]. Rev Esp Cardiol. 2006;59(6):620-623. Spanish.
    1. Baumgartner H, De Backer J, Babu-Narayan SV, et al. 2020 ESC Guidelines for the management of adult congenital heart disease. Eur Heart J. 2021;42(6):563-645. doi:10.1093/eurheartj/ehaa554
    1. Villa AD, Sammut E, Nair A, Rajani R, Bonamini R, Chiribiri A. Coronary artery anomalies overview: the normal and the abnormal. World J Radiol. 2016;8(6):537-555.
    1. Wilkins CE, Betancourt B, Mathur VS, et al. Coronary artery anomalies: a review of more than 10,000 patients from the Clayton Cardiovascular Laboratories. Tex Heart Inst J. 1988;15(3):166-173.

MeSH terms

LinkOut - more resources