Search POM Topics

Coronary Anatomy

Coronary Anatomy

Coronary Flow

Right or Left dominant coronary circulations are defined by supply of PDA (and thereby the posterior septum).  The RCA supplies the PDA in ~70% and the LCx supplies in the PDA in ~20%.  ~10% of patients have a co-dominant supply.  Around 20% of patients have a third branch of the L Main, the LIM.  When present, the LIM supplies territories usually supplied by the OM and D arteries.  The anterior 2/3 of the interventricular septum is supplied by the LAD.  The posterior 1/3 is supplied from the PDA.  The Sinoatrial nodal artery is supplied from RCA in 60% of patients and from the LCx in 40%.  The Atrioventricular branch is supplied from RCA in ~ 90-95% of patients (inc via PLVB or PDA), ~ 5% are supplied from the LCA via the LCx.

BLUE = Left coronary supply, GREEN = Right coronary supply, RED = Supplied myocardium, LMain = Left main coronary artery/ Left coronary artery, LAD = Left anterior descending artery/ Anterior interventricular branch, LCx = (Left) circumflex artery, D1, D2 etc = Diagonal Branches, OM1, OM2 etc = Obtuse marginal branches/ Left marginal arteries, RMA = Right marginal artery/ Acute marginal artery, PDA = Posterior descending artery/ Posterior (or Inferior) interventricular artery, PLVB = Posterolateral ventricular branch (or artery)/ Posterior left ventricular artery.(Represents continuation of RCA beyond the origin of PDA.), LIM = (Left) intermediate artery/ Ramus intermedius artery.  RCA = Right coronary artery

Stent Thrombosis risk Assessment

Risk Factors for In Stent Thrombosis

Stent Factors1,2,3

  • Long stent length (ie > 60mm)
  • Bifurcated stents: bifurcation with 2 stents implanted
  • Previous stent thrombosis on adequate antiplatelet therapy
  • ≥ 3 coronary artery lesions treated
  • ≥ 3 stents implanted
  • Small diameter stent (<2.5mm)
  • Incomplete revascularisation
  • Treatment of chronic total occlusion
  • Stenting of last remaining coronary artery

Risk Factors for In Stent Thrombosis

Patient Factors1

  • Presentation with Acute Coronary Syndrome
  • Diabetes
  • LVEF < 40%
  • Chronic Kidney Disease (CrCl < 40ml/min)
  • Diffuse Multivessel Disease

Left Ventricular Anatomy and Coronary Perfusion on TTE

ECG Leads by Coronary Territory

References

  1. A Comprehensive Update On Aspirin Management During Noncardiac Surgery 2020
  2. UpToDate - Clinical use of intracoronary bare metal stents - Last Update 16-12-2020
  3. Incomplete Revascularization Is Associated With an Increased Risk for Major Adverse Cardiovascular Events Among Patients Undergoing Noncardiac Surgery - JACC 2017
Subscribe
Notify of
2 Comments
Inline Feedbacks
View all comments

Topic Contents
error: Alert: Content is protected !!