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Percutaneous transluminal angioplasty for shepherd's crook right coronary artery stenosis
D E Gossman1, E M Tuzcu, C Simpfendorfer
1Department of Cardiology, Cleveland Clinic Foundation, OH 44106.
Insights
The "shepherd's crook" coronary artery variation occurs in 4.9% of patients. This anatomical variation increases procedural difficulties and lowers success rates during right coronary artery angioplasty.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Anatomy
Background:
- The right coronary artery (RCA) typically arises from the anterior aspect of the aorta.
- Anatomical variations in coronary artery origins can impact percutaneous coronary interventions.
- The "shepherd's crook" RCA is a rare variation where the artery arises from a more posterior and superior position.
Purpose of the Study:
- To determine the incidence of the "shepherd's crook" origin of the right coronary artery.
- To compare the outcomes and technical difficulties of RCA angioplasty in patients with this variation versus a control group.
Main Methods:
- Retrospective review of angiograms from 1,043 consecutive patients undergoing RCA angioplasty.
- Identification of the "shepherd's crook" RCA anatomical variation.
- Comparison of primary success rates, complications, and technical difficulties between patients with the variation and a control group.
Main Results:
- The "shepherd's" crook RCA variation was identified in 51 patients (4.9%).
- Patients with this variation had a lower primary success rate (86%) compared to the control group (98%).
- The incidence of procedural difficulties was significantly higher (33% vs. 13%) in the "shepherd's" crook group, requiring more guiding catheters and guidewires.
Conclusions:
- The "shepherd's crook" RCA is an uncommon but significant anatomical variation.
- Angioplasty of the "shepherd's crook" RCA presents technical challenges.
- This variation is associated with a reduced primary success rate and increased procedural complexity.
Abstract:
Angiograms from 1,043 consecutive patients undergoing right coronary artery angioplasty were reviewed to determine the incidence of "shepherd's crook" origin of the right coronary artery. Primary results, complications, and technical difficulties were compared with a control group. Fifty-one patients (4.9%) were found to have this anatomic variation. Compared with a control group, the primary success rate was lower (86% vs. 98%) and the incidence of procedural difficulties was higher (33% vs. 13%). Technical problems led to the use of more guiding catheters and more guidewires per patient than in the control group. Thus, coronary angioplasty of shepherd's crook right coronary artery imposes technical problems and is associated with less than an optimal primary success rate.