Coronary ostium-straight tube or funnel-shaped? A computerized tomographic coronary angiography study

The 3D configuration of the aortic-coronary junction is decisive in stenting ostial coronary lesions. We hypothesized that it varies between straight to funnel-shaped tubes and studied arterial orifices using computerized tomographic coronary angiography (CTCA).

Axial and sagittal 2-D and volumetric 3-D reconstructions of the aorto-coronary junction were performed in 25 patients who underwent CTCA. The following measurements of the left main (LM) and right coronary (RCA) arteries ostia were obtained: the coronary orifice broad base diameter, the diameter of the coronary vessel most proximal segment, the distance between them, and the angles of the aortic-coronary junction. All patients exhibited a funnel-shaped aortic-coronary junction in at least one plane, and none had an entirely straight tube shape. The RCA take-off had symmetric angling in both the axial and sagittal planes in only one patient, while the LM did not have a symmetric origin in either plane in any patient. The mean coronary orificial funnel depth and ostial cross-sectional diameters were measured.

The frequency of funnel-shaped and asymmetry of the aortic-coronary junction configuration needs to be considered in designing stents for aortic-ostial coronary lesions in order to achieve optimal results and reduce restenosis.