Coronary Angiogram

Angiogram anatomy

• remember there are many physiologic variations of normal
• RCA (Right Coronary Artery)
  • Sino-atrial nodal branch
  • AM (Right Acute Marginal)
  • PD (Posterior Descending)
  • PL (Posterior Lateral)

• LM (Left Main, Left Coronary Aftery)
  • LCx (Left Circumflex)
    • OM (Obtuse Marginal)
  • RI (Ramus Intermedius)
    • can see if LM is trifurcated
  • LAD (Left Anterior Descending)
    • notably has septal perforator branches

Angiographic views

https://www.wikidoc.org/index.php/Coronary_angiography_standard_views

Questions to ask

• Is the coronary system Right or Left dominant?
• Where are areas of significant disease?
  • Significant disease = 50% stenosis in LM or 70% in all other vessels
  • Is this single or multi vessel disease
  • Is there left main disease?
• Would PCI or CABG or hybrid approach be most appropriate?
  • Indications for PCI vs. CABG
• If PCI
  • How many stents would be appropriate?
  • ?Other considerations
• If CABG
  • How many bypass grafts would be appropriate?
  • Are there good bypass targets?
  • What type of graft is appropriate?
    • Arterial - consider competitive flow, LIMA, RIMA, radial
    • Venous - SVG