ct coronary angiography dr rodney wu - otago.ac.nz · normal coronary artery anatomy . coronary...
TRANSCRIPT
![Page 1: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/1.jpg)
CT Coronary Angiography Dr Rodney Wu
Dr Rodney Wu Pacific Radiology
![Page 2: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/2.jpg)
![Page 3: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/3.jpg)
Scanning technique
Patient preparation
Physiologic basis
Normal Coronary artery anatomy
Calcium Score
Indications for Coronary CT Angiography
Screening of Asymptomatic patients
Examination of Symptomatic patients
Specialised applications
![Page 4: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/4.jpg)
Source: Radiologic Clinics of North America 2010; 48:657-674 (DOI:10.1016/j.rcl.2010.04.003 ) Copyright © 2010 Elsevier Inc. Terms and Conditions
Scanning technique
![Page 5: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/5.jpg)
Source: Radiologic Clinics of North America 2010; 48:657-674 (DOI:10.1016/j.rcl.2010.04.003 ) Copyright © 2010 Elsevier Inc. Terms and Conditions
![Page 6: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/6.jpg)
Patient Preparation
No solids
Hydration with clear fluids
No caffeine products
Abstinence from Erectile dysfunction meds 24-48hr as may interact with nitrates to cause severe hypotension
Beta blocker HR<70bpm preferably <60bpm
Calcium score
Triphasic IV contrast
Timing bolus
![Page 7: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/7.jpg)
![Page 8: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/8.jpg)
Physiologic basis
Heart is mobile around its axis
Volume varies between systole/diastole
Coronary artery filling easier in diastole
On ECG diastole begins later than R-wave and lasts until Q-wave
On the ECG the centre of diastole is at 70% of an R-R complex
Retrospective gating
Prospective ECG gating
ASIR (Adaptive statistical IR)
![Page 9: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/9.jpg)
Normal Coronary Artery Anatomy
![Page 10: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/10.jpg)
![Page 11: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/11.jpg)
Left Coronary Artery
LMA
LAD
Diagonals
Circumflex
Obtuse Marginals
![Page 12: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/12.jpg)
![Page 13: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/13.jpg)
LMA
LAD
Diagonals
Circumflex
Obtuse Marginals
![Page 14: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/14.jpg)
![Page 15: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/15.jpg)
![Page 16: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/16.jpg)
LMA
LAD
Diagonals
Circumflex
Obtuse Marginal
![Page 17: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/17.jpg)
![Page 18: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/18.jpg)
![Page 19: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/19.jpg)
LMA
LAD
Diagonals
Circumflex
Obtuse Marginals
![Page 20: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/20.jpg)
![Page 21: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/21.jpg)
![Page 22: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/22.jpg)
Right Coronary Artery
Right Coronary Artery
Posterior Descending Artery
Posterolateral Artery
![Page 23: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/23.jpg)
![Page 24: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/24.jpg)
![Page 25: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/25.jpg)
![Page 26: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/26.jpg)
Calcium Score
![Page 27: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/27.jpg)
![Page 28: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/28.jpg)
![Page 29: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/29.jpg)
![Page 30: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/30.jpg)
Indications for Coronary CT Angiography
Screening of Asymptomatic patients
Examination of symptomatic patients
Specialised applications
![Page 31: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/31.jpg)
Screening of Asymptomatic patients
![Page 32: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/32.jpg)
The presence of coronary atherosclerosis and the subsequent manifestations of coronary disease exist on a continuum
High plaque burden may exist yet remain asymptomatic and undetectable at conventional testing
![Page 33: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/33.jpg)
![Page 34: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/34.jpg)
Standard Framingham risk factors help identify groups at low, high and intermediate risk for future cardiac events.
Low risk: likelihood of cardiac events of <10% per 5 years
High risk: likelihood of cardiac events of >20% over a 5 year period considered to be at high risk.
![Page 35: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/35.jpg)
Asymptomatic low risk patient according to Framingham criteria is less likely to gain further benefits from additional cardiac testing.
Low risk patients are most likely to have false-positive results owing to a low pretest likelihood of disease
Asymptomatic intermediate risk group most likely to benefit from further risk stratification
40% population belong in intermediate risk group
![Page 36: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/36.jpg)
40m Asymptomatic FHx
![Page 37: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/37.jpg)
40M Asymptomatic FHx
![Page 38: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/38.jpg)
Mild stenosis LAD, LCX and RCA
![Page 39: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/39.jpg)
Mild stenosis LAD, LCX and RCA
![Page 40: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/40.jpg)
53M Asymptomatic, +ve family hx
![Page 41: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/41.jpg)
50% LAD stenosis confirmed on angio with pressure wire indicating obstructive. Pt went to CABG.
![Page 42: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/42.jpg)
50% LAD stenosis confirmed on angio with pressure wire indicating obstructive. Pt went to CABG.
![Page 43: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/43.jpg)
51M Asymptomatic, abnormal stress test
![Page 44: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/44.jpg)
Soft and calcified plaque LAD <50%
LCX 30% stenosis
RCA small plaques
![Page 45: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/45.jpg)
![Page 46: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/46.jpg)
![Page 47: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/47.jpg)
Examination of Symptomatic patients
![Page 48: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/48.jpg)
Atypical chest pain
Patients with atypical chest pain with low to intermediate risk would benefit from a non invasive test with a high negative predictive value.
A normal CT angiogram and negative calcium score could avoid invasive cardiac catheterization in a substantial % of patients.
CT also helpful when other tests are negative or equivocal.
![Page 49: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/49.jpg)
Typical chest pain
CT is not recommended for patients with Acute Coronary Syndrome and high risk factors.
CT can reveal non cardiac causes of chest pain.
The use of CT in evaluation of chest pain in ED is currently being explored. The “Triple rule out” to evaluate aortic dissection, PE and acute coronary syndrome. Not currently recommended.
![Page 50: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/50.jpg)
72F borderline ETT. No chest pain
![Page 51: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/51.jpg)
72F borderline ETT. No chest pain
![Page 52: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/52.jpg)
64M atypical chest pain, smoker
![Page 53: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/53.jpg)
LAD 70% stenosis x2
2nd OM 70% stenosis
Occluded RCA
![Page 54: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/54.jpg)
Confirmed on ANGIOGRAM went onto CABG
![Page 55: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/55.jpg)
Confirmed on ANGIOGRAM went onto CABG
![Page 56: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/56.jpg)
65M chest pain with exercise, +ve fam hx
![Page 57: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/57.jpg)
Prox LAD 70% + stenosis
![Page 58: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/58.jpg)
Distal RCA >50% stenosis
![Page 59: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/59.jpg)
67F angina, HT
![Page 60: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/60.jpg)
75% distal LMA stenosis
![Page 61: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/61.jpg)
Confirmed on angiogram, went onto CABG
![Page 62: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/62.jpg)
71m symptomatic aortic stenosis
![Page 63: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/63.jpg)
71m symptomatic aortic stenosis
![Page 64: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/64.jpg)
LMA and LAD 50%, RCA 70% stenosis
![Page 65: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/65.jpg)
Specialised applications
![Page 66: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/66.jpg)
CT can be used to evaluate bypass grafts and stents.
Evaluation of patients undergoing valve surgery but unlikely to have coronary artery disease.
Pre cardiac catheter planning
![Page 67: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/67.jpg)
57M for redo AVR
![Page 68: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/68.jpg)
![Page 69: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/69.jpg)
68F aortic valve vegetation
![Page 70: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/70.jpg)
47M chest pain
![Page 71: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/71.jpg)
![Page 72: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/72.jpg)
![Page 73: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/73.jpg)
67M LAD aneurysms preop planning
![Page 74: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/74.jpg)
Vein graft aneurysm
![Page 75: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/75.jpg)
Pre cardiac cath planning
51 M
Occluded mid RCA
Stents mid LAD and OM1
Severe stenosis mid LAD
![Page 76: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/76.jpg)
Stents LAD/OM1
![Page 77: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/77.jpg)
Soft plaque occluding RCA
![Page 78: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/78.jpg)
Collaterals from the LCX with retrograde filling of PLA
![Page 79: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/79.jpg)
66M Cardiologists unable to demonstrate RCA at angiography
![Page 80: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/80.jpg)
66M Cardiologists unable to demonstrate RCA at angiography
![Page 81: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/81.jpg)
![Page 82: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/82.jpg)
![Page 83: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/83.jpg)
Conclusion
CT angiography allows visualization of the coronary arteries which previously required invasive cardiac catheterization.
It should not be directly compared with cardiac cath as it offers different information non invasively. It directly identifies early stages of plaque formation before it can be seen on cardiac angiography.
Patients who have undergone revascularization procedures including stenting and bypass can now be imaged non-invasively.
![Page 84: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/84.jpg)
Advantages Disadvantages
Quick and non-invasive
3D modality
Accurate and unique info
Most sensitive test in detection of coronary artery disease other than IVUS
Can see other vessels and structures in chest
Involves radiation (down to <1msv with prospective gating)
Difficult in fast or irregular heartbeats
Requires contrast and beta blockers
Can be difficult and occasionally impossible to quantify stenosis in heavily calcified or small vessels.
![Page 85: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/85.jpg)
![Page 86: CT Coronary Angiography Dr Rodney Wu - otago.ac.nz · Normal Coronary Artery Anatomy . Coronary arteries arise from the aorta. The RCA arises from the right aortic sinus and the LMA](https://reader030.vdocument.in/reader030/viewer/2022040206/5e06df92d46a2341714cdfe0/html5/thumbnails/86.jpg)