Presence of ramus intermedius increases the risk of atherosclerotic plaque formation at the left main bifurcation's region: A retrospective study from CT coronary angiography in UMMC

ROSANI, NURUL SAZMI; Zamin, Rasheeda Mohd; Zulkafli, Intan Suhana; Azman, Raja Rizal; Zuhdi, Ahmad Syadi Mahmood; Danaee, Mahmoud

doi:10.1016/j.ijcard.2021.10.069

Cited by 1 publication

(3 citation statements)

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“…However, if RI is precisely positioned between these arteries, its effect on their proximal diameter is minimal [19]. Additionally, some data indicate that the existence of RI is associated with an increased risk of branch point atherosclerosis [10,11,12,20]. These considerations underscore the complex interplay between RI anatomy and its potential implications for coronary artery health.…”

Section: Discussionmentioning

confidence: 99%

“…Some reports suggest that the presence of RI increases the risk of atherosclerotic plaque formation and obstructive lesions in the left main and proximal LAD [10,12]. Zhang et al demonstrated that the presence of RI is not an independent risk factor for atherosclerotic plaque formation in the LMCA bifurcation zone, but it may indirectly increase the risk of atherosclerosis in the proximal segment of the LAD [11].…”

Section: Discussionmentioning

confidence: 99%

“…Consequently, the RI, as an additional flow divider, may potentially contribute to the generation of additional pathologic shear stress, atherosclerotic plaque formation, and damage to the coronary endothelium [ 9 ]. Consistent with this hypothesis, some data have emerged, indicating that the presence of RI is associated with an elevated risk of atherosclerotic plaque development within the LMCA and the proximal segment of the LAD [ 10 - 12 ].…”

Section: Introductionmentioning

confidence: 92%

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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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