Frequency and clinical significance of failure to visualize the conus artery during coronary arteriography

In patients with occlusion of the left anterior descending coronary artery (LAD) or right coronary artery (RCA), the conus artery, which arises at or near the origin of the RCA, often serves as a principal source of collateral circulation. Coronary arteriograms in 508 adult patients revealed that in 80.5% the conus artery was well visualized on the RCA angiogram, but that in 19.5% it was not adequately visualized due to injection of contrast distal to its origin. In the latter patients, the presence of conus-LAD or conus-RCA collaterals might therefore go undetected. Because the degree of distal filling via collateral circulation affects medical and surgical decisions, it is important to attempt to visualize the conus artery adequately whenever the LAD or RCA is obstructed.