Catheter selection for coronary angiography and intervention in anomalous right coronary arteries

An anomalous origin of the right coronary artery (ARCA) from the left sinus of Valsalva (LSOV) has been reported in 6-27% of patients with coronary anomalies. The unusual location and course of this anomaly poses a technical challenge for the interventionalist. Appropriate guiding catheter selection is critical to ensure successful angiography and percutaneous intervention (PCI). We report our experience in 24 patients with an anomalous RCA originating from the LSOV.

Twenty-four angiograms of ARCA-LSOV were reviewed by two independent interventionalists with attention to the origin and take off of the RCA within the aortic root. The origin was adjudicated with a scheme based on anatomical landmarks as described-A: origin from the aorta above the sinotubular plane; B: origin just below the ostium of the left coronary artery (LCA); C: origin below the sinotubular plane between the midline and the LCA; D: origin along the midline.

The distribution of various takeoffs of the RCA was as follows: For type A (N = 4) the FL3.0 and FCL3.0 catheters were successful in three and one cases, respectively. For type B (N = 5) the FCL3.0 or 3.5 was successful in four out of the five cases. For type C (N = 9) the VL catheter was successful in eight (VL3.5 = 5:VL 3.0 = 3) cases. The AL catheter was successful in five cases of type D (N = 6) RCAs (AL1 = 3:AL2 = 1:AL3 = 1).

The classification method and catheter selection provide a useful framework to successfully engage ARCA-LSOV and may reduce contrast and radiation exposure.