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Published on: August 28, 2018
The prevalence and anatomical patterns of intramuscular coronary arteries: a coronary computed tomography
Eli Konen1, Orly Goitein, Leonid Sternik
1Department of Diagnostic Imaging, Sheba Medical Center and Tel Aviv University, Tel Aviv, Israel.
Insights
Intramuscular coronary arteries (myocardial bridging) were found in 30.5% of patients using coronary computed tomographic angiography (CCTA). CCTA imaging provides detailed anatomical information valuable for surgical planning.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Cardiac Anatomy
Background:
- Prevalence of intramuscular coronary arteries (myocardial bridging) varies significantly across different diagnostic methods.
- Intramuscular coronary arteries can complicate coronary bypass surgery, posing risks like inadvertent ventricular perforation.
Purpose of the Study:
- To determine the prevalence and radiologic patterns of intramuscular coronary arteries using coronary computed tomographic angiography (CCTA).
- To assess the utility of CCTA in visualizing myocardial bridging.
Main Methods:
- 118 patients underwent CCTA using a 64-multidetector CT scanner.
- Evaluated parameters included the number, length, depth, and course of intramuscular coronary segments.
- Analyzed arterial diameter and atherosclerosis proximal and within intramuscular segments.
Main Results:
- Intramuscular coronary arteries were identified in 30.5% of patients (36 of 118).
- Most segments were in the left anterior descending (LAD) artery, with three distinct CCTA patterns observed.
- Segment lengths ranged from 13-40 mm, with reduced diameter within the intramuscular course.
Conclusions:
- CCTA reveals a higher prevalence of intramuscular coronary arteries compared to traditional angiography, aligning with pathological data.
- CCTA effectively visualizes the presence, course, and anatomical characteristics of myocardial bridging.
- CCTA offers valuable preoperative information for patients undergoing coronary bypass surgery.
Objectives:
This study sought to report prevalence and radiologic patterns of intramuscular coronary arteries (myocardial bridging) on coronary computed tomographic angiography (CCTA).
Background:
Reported prevalence of intramuscular coronary arteries varies between 5% and 86% in autopsy and 0.8% and 4.9% in coronary angiography. Intramuscular coronary arteries can cause technical problems during coronary bypass surgery, including inadvertent perforation of the right ventricle.
Methods:
One hundred and eighteen consecutive patients were studied with CCTA using Brilliance 40/64 multidetector computed tomography (Philips Medical Systems, Cleveland, Ohio). Parameters evaluated were number, length, and depth of intramuscular coronary segments; diameter and evidence of atherosclerosis in the involved artery proximal and within the intramuscular segment; and its course in relation to the interventricular septum and right ventricular wall.
Results:
Forty-seven intramuscular segments were identified in 36 of 118 (30.5%) patients. Most were located in mid left anterior descending coronary artery (LAD), 27 of 47 (57%), and distal LAD, 7 of 47 (15%). The CCTA features in the LAD showed 3 patterns: superficial septal, 10 of 34 (29.4%); deep septal, 14 of 34 (41.1%); and right ventricular type, 10 of 34 (29.4%). Intramuscular segment length ranged from 13 to 40 mm. Coronary diameter proximal and within the affected segment was 2.2 +/- 0.5 mm versus 1.6 +/- 0.6 mm for the LAD, and 1.9 +/- 0.3 mm versus 1.5 +/- 0.6 mm for the remaining arteries, respectively. Depth ranged from 0.1 to 5.6 mm.
Conclusions:
Prevalence of intramuscular coronary arteries on CCTA is in concordance with most pathological reports and higher than in angiographic series. The CCTA clearly showed presence, course, and anatomical features of intramuscular coronary arteries. Coronary computed tomographic angiography may provide potentially useful information in the preoperative evaluation of candidates for coronary bypass surgery.
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