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Coronary anatomy: Difference between revisions
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A randomized trial published in 2008 shower that transradial coronary angiography was safe, feasible and effective with similar results to those of the transfemoral approach. The Access trial performed by Kiemeneij et al showed similar procedural and clinical outcomes of PCI in transradial, transbrachial and transfemoral PCI. Major access site complications were lower in the transradial group, but with higher access failure (coronary cannulation) . Procedural duration and radiation exposure are higher using transradial access, but with significantly lower rate of major vascular complications . In STEMI patients, the HORIZONS-AMI trial showed that the transradial approach was associated with reduced major bleeding and improved event-free survival . | A randomized trial published in 2008 shower that transradial coronary angiography was safe, feasible and effective with similar results to those of the transfemoral approach. The Access trial performed by Kiemeneij et al showed similar procedural and clinical outcomes of PCI in transradial, transbrachial and transfemoral PCI. Major access site complications were lower in the transradial group, but with higher access failure (coronary cannulation)<cite>Kiemeneij</cite>. Procedural duration and radiation exposure are higher using transradial access, but with significantly lower rate of major vascular complications<cite>Brueck</cite>. In STEMI patients, the HORIZONS-AMI trial showed that the transradial approach was associated with reduced major bleeding and improved event-free survival<cite>Genereux</cite>. | ||
==Coronary anatomy== | |||
===''Anatomy''=== | |||
[[File:coronary_anatomy1.png <cite>Fauci</cite>]] | |||
The main coronary arteries may be considered to be located in two planes: the plane of the atrioventricular groove and the plane of the interventricular septum . | |||
The right coronary artery (RCA) originates in the right sinus of Valsalva and runs in the right ventricular side of the atrioventricular groove. At the crux the posterior descending artery (RDP) and atrioventricular node artery originate. If the RCA continues after the RDP to supply a portion of the posterior left ventricular wall (RPL), it is called a right dominant circulation (85% of people). If the LCA supplies the posterior left ventricular wall (LPL) the coronary circulation is called left dominant (5%), in 10% of people there is balanced system. The RDP runs in the posterior interventricular groove. In 60% the sinus node artery arises from the proximal portion of the RCA. | |||
The left main coronary artery (LMCA) originated in the left sinus of Valsalva. Its length varies from 5-10mm. Sporadically the LMCA is absent, resulting in separated ostia of RCx and LAD. Sometimes there is a trifurcation, with a branch between the RCx and LAD called | |||
== References == | == References == | ||
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#Jukema3 JW, Vliegen HW, Bruschke AVG. Coronary angiography: principles, technique and interpretation. 1e druk, Leiden, the Netherlands, 2009. Chapter 2: 10. | #Jukema3 JW, Vliegen HW, Bruschke AVG. Coronary angiography: principles, technique and interpretation. 1e druk, Leiden, the Netherlands, 2009. Chapter 2: 10. | ||
#Caputo pmid=21544927 | #Caputo pmid=21544927 | ||
#Kiemeneij pmid=9137223 | |||
#Brueck pmid=19926042 | |||
#Genereux pmid=22157475 | |||
#Fauci Fauci AS, Kasper DL, Braunwald E, Hauser SL, Longo DL. Harrison’s Principles of Internal Medicine, 17th edition: http://www.accessmedicine.com | |||
</biblio> | </biblio> | ||