Intracavitary Coronary Artery

Abstract

Purpose: A few case reports of intracavitary coronary arteries (ICCA) have been reported and only a single case series on the coronary computed tomography angiography (CCTA) prevalence rate of ICCA of the right coronary artery (RCA). We describe several cases of ICCA that were noted incidentally and also determine the overall prevalence rate of anomalous ICCA. Materials and Methods: A retrospective analysis of ICCA was performed consisting of consecutive CCTA cases as well as a group of ICCA from teaching files. To establish a prevalence rate, we reviewed 464 consecutive CCTA referred to our center for transcatheter aortic valve replacement. The presence of ICCA and several imaging features were evaluated. Results: Our cohort comprises a total of 12 patients with ICCA, with 1 patient containing 2 anomalous ICCA. 83.3% of affected patients were adult males, with an average age of 69.8 years. The RCA was the most commonly affected vessel (53.8%). The mean length of the intracavitary segment was 33.4 mm for the RCA and 27 mm for the LAD. No cases involved the left circumflex coronary artery. Six of the cases were identified routinely as part of clinical practice and therefore not included in the prevalence analysis. On review of our transcatheter aortic valve replacement database, there was a 1.3% prevalence rate of ICCA. RCA had a prevalence of 0.4%, whereas LAD had a prevalence of 0.9%. Conclusions: Although rare, our study suggests that ICCA may be more common than previously described. Its presence is important to communicate to clinicians prior to invasive cardiac procedures to prevent potentially catastrophic outcomes.

Intramyocardial and Intra-atrial courses in the Right Coronary Artery: Prevalence and characteristics

“…Consistent with the broader scholarly discourse, where sex disparities are generally not emphasized, Hossain et al identi ed a predilection for IARCA occurrences in males [9]. Although a higher prevalence among males is noted in our cohort, with males constituting 4 of the 7 cases, the sample size is limited.…”

“…An atrialized coronary artery denotes a segment of the RCA coursing superiorly to its typical epicardial position within the atrioventricular groove, representing a rare and atypical condition for the RCA [8]. Radiologically, IARCA is characterized as an RCA segment entirely encompassed by intra-atrial contrast throughout the cardiac cycle, in contrast to MB, where the coronary artery segment appears entirely surrounded by myocardial muscle [9]. Recognition of IARCA prior to cardiac surgery or endocavitary procedures is imperative, given its potential for vascular injury leading to catastrophic consequences [10].…”