Anatomy, histology, and pathology of coronary arteries: A review relevant to new interventional and imaging techniques—Part I

Abstract

Summary:In the last 15 years, intense interest has focused on various interventional pharmacologic and mechanical forms of therapy for the treatment of atherosclerosis coronary artery disease. Many techniques and devices (dilating balloons, perfusion catheters, thermal probes and balloons, lasers, atherectomy devices, stents, intravascular ultrasound) have been used or are under study for future use. Many of these techniques and devices require an understanding of histologic and pathologic features of the coronary arteries and diseases which affect them. This article reviews selective areas of anatomy, histology, and pathology relevant to the use of various new interventional Part I of this review will focus on anatomic aspects of the epicardial coronary artery system, coronary arterial distribution, myocardial supply, and histologic features of the normal coronary artery. Key words: coronary artery, coronary ostium, high takeoff position Epicardial Coronary Artery SystemThe epicardial coronary artery system consists of the left and right coronary arteries, which normally arise from 0s-tia located in the left and right sinuses of Valsalva, respec- tively ( Fig. 1). In about 50% of humans a "third coronary artery" ("conus artery") arises from a separate ostium in the right sinus. Additional smaller ostia may be found in the right sinus, which give rise to multiple right ventricular branches (Fig. 2). Up to five separate coronary ostia have been described (Figs. 2+.3 The left main coronary artery ranges in length from 1-25 mm before bifurcating into the left anterior descending and left circumflex bran~hes.~ The left anterior descending coronary artery measures from 10-13 cm in length, whereas the usual nondominant left circumflex artery measures about 6-8 cm in length. The usual dominant right coronary artery (supplying posterior descending and/or atrioventricular nodal artery) is about 12-14 cm in length before giving rise to the posterior descending artery. The luminal diameters of the major coronary arteries in adults range as follows: left main, 2.0-5.5 mm (mean 4 mm); left anterior descending, 2.0-5.0 mm (mean 3.6 mm); left circumflex, 1.5-5.5 mm (mean 3.0 mm); and right, 1.5-5.5 mm (mean 3.2 mm)? Although the left anterior descending and left circumflex arteries generally taper in diameter as each extends from the left main bifurcation, the right coronary artery maintains a fairly constant diameter until just before the origin of its posterior descending branch. The subepicardial coronary arteries run on the surface of the heart embedded in various amounts of subepicardial fat. Portions of the epicardial coronary arteries may dip into the myocardium ("mural artery" or "tunneled artery") and be covered for a variable length (1 to several mm)5 by ventricular muscle ("myocardial bridge") ( Coronary OstiaThe left and right coronary ostia arise normally within the sinus of Valsalva or at the junction of the sinus and tub-

A computational framework to characterize and compare the geometry of coronary networks

“…Our data indicate that the main coronary arteries (LAD, LCx, and RCA) have a mean length of roughly 130, 60, and 120 mm, which matches anatomical data [54,59]. Mean lengths of diagonal and obtuse branches of the LAD and LCx tend to decrease from proximal to distal, while proximal branches of the RCA are shorter than mid-distal ones.…”

Frequency of Complete Atrioventricular Block Complicating ST-Elevation Myocardial Infarction in Patients Undergoing Primary Percutaneous Coronary Intervention

“…The AV node is supplied by the AV nodal artery which is a branch of the RCA, and the AV node also receives collaterals from the septal branches of the proximal LAD. An ischemic insult disrupts the conduction tissue and causes CAVB due to the enhanced parasympathetic tone from the release of adenosine, potassium, and acetylcholine [17]. The ischemic insult usually leads to a transient CAVB and is usually resistant to a permanent effect due to the high intracellular content of glycogen, the complex and rich blood supply with Values are presented as numbers (%) unless otherwise stated.…”

Identification of Coronary Artery Orifice to Prevent Coronary Complications in Bioprosthetic and Transcatheter Aortic Valve Replacement

“…17-19 Such a location is called a high takeoff and can be a cause of sudden death. 17 In contrast, cases of low takeoff, that is, distance 6.3 mm from the annulus, have also been reported. 20 In low takeoff cases, the distance between the sewing cuff and coronary artery orifice is very short, which can lead to obstruction of the orifice by the cuff.…”