Complex LAD lesion in RAO cranial view – video

Complex LAD lesion in RAO cranial view – video

Complex LAD lesion: Coronary angiogram video

Left coronary angiogram in right anterior oblique (RAO) cranial view showing complex lesion of left anterior descending coronary artery (LAD), involving diagonal ostium and the ostium of a septal perforator. Septal perf: septal perforator branch of LAD; Diag: diagonal branch of LAD

There is mild tapering of the distal left main coronary artery just prior to the origin of the left circumflex coronary artery and left anterior descending coronary artery. Proximal left anterior descending coronary artery has a short segment of ostioproximal stenosis followed by a a short segment with minimal ectasia. Ectactic segment tapers towards the origin of the first diagonal branch which has ostial stenosis and proximal irregular disease. Beyond the origin of the first diagonal, till the origin of the first septal perforator branch, LAD tapers rapidly to about 90% stenosis. Septal perforator has tight ostial stenosis. Short segment beyond the stenosis, LAD gives rise to the second diagonal branch. Distal LAD beyond this diagonal branch does not have significant disease and is  a type III vessel.

Successful coronary angioplasty of a complex left anterior descending coronary artery lesion associated with a myocardial bridge in an 86 year old person with chronic angin, recent myocardial infarction and refractory post infarction angina has been described by Cohen HM et al [1].

Reference

1. Cohen HM, Juska J, Kleiman JH. PTCA of complex atherosclerotic lesion at site of LAD myocardial bridging. Cathet Cardiovasc Diagn. 1996 Mar;37(3):272-6.