LMCA distal and tight LAD disease LAO caudal view
Coronary angiogram still shot showing distal left main coronary artery (LMCA) and tight left anterior descending (LAD) coronary artery disease in left anterior oblique (LAO) caudal view. Conventionally this is an indication for coronary artery bypass grafting (CABG), though currently most operators would also consider PTCA (percutaneous transluminal angioplasty) with stenting for this type of disease due to the availability of better PTCA hardware including drug eluting stents.
LMCA distal and tight LAD disease LAO caudal view - annotated
LCX: left circumflex coronary artery. Ostial involvement of LAD is better appreciated in the previous image.
LMCA distal and tight LAD disease RAO caudal view
Right anterior oblique (RAO) caudal view also demonstrates the ostial disease of LAD nicely. Tapering of the distal left main is also evident in this view. The circumflex ostium seems to relatively spared in this view. LCX (and hence the left coronary artery) is a dominant vessel here as it gives rise to the posterior left ventricular (PLV) and posterior descending coronary artery (PDA). OM: obtuse marginal branch of LCX. PLB: posterior left ventricular branch. PLV (PLB) and PDA are not marked in the image, but are the terminal branches of the LCX seen at the bottom of the image.
Non dominant right coronary artery
Non dominant right coronary artery is seen to be an insignificant vessel. This emphasises the urgent need to revascularise the left coronary artery territory at the earliest.