Effect of Presence of Ramus Intermedius Artery on Location of Culprit Lesions in Acute Left Circumflex Coronary Artery Occlusion

Zayat, Ahmed El; El-Deeb, Mohamed A.; Gad, Marwa; Ibrahim, Ismail Mohamed

doi:10.37616/2212-5043.1238

Cited by 3 publications

(2 citation statements)

References 19 publications

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“…The incidence of LCX proximal segment plaques in this study was not statistically significant (P > 0.05) when compared between and within groups, which is consistent with the findings of El Zayat, Rosani, El Zayat [ 18 ]suggested that it was due to low longitudinal strain in LCX. In contrast to the results of the Rosani study, there was no statistical difference between the LM plaque groups in this study, which we believe may be equally influenced by the inconsistent risk factors included in both studies and needs to be further investigated in depth.…”

Section: Discussionsupporting

confidence: 89%

Coronary computed tomography angiography study on the relationship between the Ramus Intermedius and Atherosclerosis in the bifurcation of the left main coronary artery

Zhang

Dong

et al. 2023

BMC Med Imaging

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Objective This study aimed to explore the relationship between the ramus intermedius (RI) and atherosclerosis in the bifurcation of the left coronary artery (LCA). Methods Screening patients who underwent CCTA from January to September 2021, 100 patients with RI (RI group) and 100 patients without RI (no-RI group) were randomly enrolled, Evaluation of RI distribution characteristics and left main coronary artery(LM),Left anterior descending branch(LAD),left circumflex branch(LCX) proximal segment plaque distribution, measurement of LAD-LCX bifurcation angle(∠LAD-LCX),Comparison of the three distribution characteristics with the incidence of plaques in the left main trunk bifurcation area (LM, LAD, LCX) between groups and within the RI group. Results The difference in the incidence of plaques in the proximal LCX and the LM between the RI group and the no-RI group were not statistically significant (P > 0.05). The incidence of plaques in the proximal LAD in the RI group was significantly higher than that in the non-RI group (77% versus 53%, P < 0.05). However, there was no statistically significant difference between the two groups after PSM. A univariate logistic regression analysis revealed that an RI was a risk factor for plaque formation in the proximal LAD (P < 0.001), and a multivariate logistic regression analysis revealed that an RI was not an independent risk factor for plaque formation in the proximal LAD (P > 0.05). When compared within the RI group, the difference in the incidence of plaques in the proximal segment of LAD, the proximal segment of LCX, and the LM among the different distribution groups of RI was not statistically significant, respectively (P > 0.05). Conclusion RI is not an independent risk factor for atherosclerosis in the left coronary artery bifurcation zone, but it may indirectly increase the risk of atherosclerosis in the proximal segment of the LAD.

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Section: Discussionsupporting

confidence: 89%

Coronary computed tomography angiography study on the relationship between the Ramus Intermedius and Atherosclerosis in the bifurcation of the left main coronary artery

Zhang

Dong

et al. 2023

BMC Med Imaging

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“…Another review highlighted the association between RI and larger anterior infarctions as well as more proximal LAD lesions [ 20 ]. Notably, this association was not observed in the case of the LCX, as the presence of RI was not associated with more proximal LCX lesions [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

The Ramus Intermedius: A Bridge to Survival in the Setting of Triple-Vessel Total Occlusion

Khachatryan,

Chow,

Srivastava

et al. 2024

Cureus

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Coronary artery disease continues to remain the leading cause of mortality worldwide. Coronary blood supply is provided through the right and left main coronary arteries. The left main coronary artery (LMCA) in turn gives rise to the left anterior descending (LAD) and left circumflex (LCX) arteries. In some cases, LMCA may trifurcate into the ramus intermedius (RI) in addition to the LAD and LCX arteries. Atherosclerotic plaque formation and rupture with subsequent clot formation and occlusion of coronary arteries are the underlying mechanisms of myocardial infarction. Though the clinical implications of the presence of ramus intermedius (RI) are controversial some data suggest that the RI is associated with an increased risk of atherosclerotic plaque formation in the LMCA and the proximal LAD. Conversely, it has been proposed that the RI provides an additional collateral source of blood supply to the myocardium and may potentially contribute to improved survival. Case reports tout the benefits of RI, specifically in the setting of multivessel coronary artery occlusions. Whether it increases the risk of atherosclerotic plaque formation or whether it is protective has yet to be determined. We present a case of a 58-year-old male who presented with acute coronary syndrome and cardiogenic shock due to total ostial occlusion of LAD. The patient had also chronic total occlusions of the right coronary artery and LCX but a patent RI, which was the only source of blood supply to the myocardium and practically determined the patient's survival. Additionally, we performed a literature review to identify similar cases, to support RI's potentially protective role in enhancing survival.

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The Role of Ramus Intermedius in Atherosclerosis Plaque Deposition at the Left Bifurcation Region: A Retrospective Study using Coronary Computed Tomography Angiography

ROSANI

Zamin

Zulkafli

et al. 2022

Preprint

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Ramus intermedius (RI) is a coronary artery anatomical variant arising from the left main bifurcation angle coursing between the left anterior descending and left circumflex arteries. RI is commonly reported in coronary artery investigations, but its role in coronary artery disease (CAD) is unknown. The objective of this study is to evaluate the contributory effects of the RI in the development of CAD at the left bifurcation region (LBR) using coronary computed tomography angiography (CCTA). A retrospective cross-sectional single-centre study was conducted on patients who underwent CCTA from January 2017 until December 2018. A total of 374 patients were included based on inclusion and exclusion criteria. The left main coronary artery (LMCA), proximal left anterior descending (pLAD), and proximal left circumflex (pLCx) arteries were analysed against known cardiovascular risks (CVR) (i.e., Absence or Presence). The RI was identified in 32% of patients (n = 121). RI singularly increases the risk for plaque deposition at the LMCA and pLAD but not in the pLCx. RI increased the risk for LMCA stenosis by eight-fold (Adjusted OR, aOR: 8.5, 95% CI: 1.7, 43.0, p = 0.010). At the pLAD, a RI increased the risk for plaque deposition at the lateral wall by three-fold (aOR: 3.5, 95% CI: 1.1, 11.3, p = 0.036) and four-fold for plaque formation on both lateral and medial walls (aOR: 4.3, 95% CI: 2.7, 17.2, p = 0.038). These findings suggested for the first time that RI pose an elevated risk for atherosclerosis in coronary arteries.

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Effect of Presence of Ramus Intermedius Artery on Location of Culprit Lesions in Acute Left Circumflex Coronary Artery Occlusion

Cited by 3 publications

References 19 publications

Coronary computed tomography angiography study on the relationship between the Ramus Intermedius and Atherosclerosis in the bifurcation of the left main coronary artery

Coronary computed tomography angiography study on the relationship between the Ramus Intermedius and Atherosclerosis in the bifurcation of the left main coronary artery

The Ramus Intermedius: A Bridge to Survival in the Setting of Triple-Vessel Total Occlusion

The Role of Ramus Intermedius in Atherosclerosis Plaque Deposition at the Left Bifurcation Region: A Retrospective Study using Coronary Computed Tomography Angiography

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