Right coronary artery anatomical variants: where and how?

Area of Science:

• Cardiology
• Interventional Cardiology
• Anatomical Variations

Background:

• Ectopic origin of the right coronary artery (RCA) is a rare anomaly, affecting about 1.0% of the population.
• Understanding its prevalence and anatomical characteristics is crucial for clinical management.

Purpose of the Study:

• To determine the prevalence and anatomical location of ectopic RCAs in patients undergoing coronary angiography.
• To evaluate the impact of ectopic RCAs on procedural resource utilization.

Main Methods:

• Prospective collection of ectopic RCA cases over 21 months during cardiac catheterization.
• Definition of ectopic RCA as originating outside the posterior two-thirds of the right coronary sinus.
• Comparison of procedural times, fluoroscopy, and contrast volume between ectopic and typical RCA origins.

Main Results:

• A prevalence of 1.1% (23 out of 2,120 patients) for ectopic RCAs was observed.
• Ectopic RCAs most commonly originated from the anterior third of the right sinus (65%) or the anterior half of the left sinus (35%).
• Patients with ectopic RCAs experienced longer procedure and fluoroscopy times, higher contrast volumes, and a 26% need for repeat procedures.

Conclusions:

• Ectopic RCAs represent a significant clinical challenge, leading to increased procedural complexity and resource consumption.
• Recommended imaging boundaries for searching ectopic RCAs include the anterior third of the right sinus and the anterior half of the left sinus.