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1.
Sudhir Rathore MD MRCP Mitsuyasu Terashima MD Takahiko Suzuki MD 《Catheterization and cardiovascular interventions》2009,74(6):873-878
Failure of guide wire crossing is the commonest reason for failed procedure in chronic total occlusion (CTO) of the coronary arteries. Intravascular ultrasound can be useful in some cases to achieve. Successful guide wire crossing into the distal true lumen of the coronary artery. We describe two cases demonstrating the role of intravascular ultrasound in successful recannalization of the CTO. © 2009 Wiley‐Liss, Inc. 相似文献
2.
Krishna Santosh Vemuri Bhupinder Kumar Sihag Yashpaul Sharma Krishna prasad Nevali Rajesh Vijayvergiya Rohit Manoj Kumar Ajay Bahl Parminder Singh Saurabh Mehrotra Suraj Khanal Neelam Dahiya Ankur Gupta Himanshu Gupta Sanjeev Naganur kumar Basant Prashant Panda Ankush Gupta Parag Barwad 《Indian heart journal》2021,73(2):156-160
ObjectivesThe aim of this study is to determine the prevalence, clinical characteristics, angiographic profile and predictors of outcome for percutaneous coronary interventions (PCI) of coronary chronic total occlusions (CTO) in a tertiary referral centre of north India.BackgroundThere is no data on the prevalence and very few reports on clinical characteristics, angiographic profile and outcome of PCI in CTO from India.MethodsRetrospective analysis was done for the data of 12,020 patients undergoing coronary angiography (CAG) between January 2018 to January 2019 at our centre. Detailed baseline clinical, angiographic and revascularization data was collected. Outcome of CTO PCI was also noted. All baseline parameters were analysed for predicting the outcome of CTO PCI.ResultsCTO was identified in 16.3% (1968) patients undergoing CAG and in 24.4% of patients with hemodynamically significant CAD. CTO was predominantly found in LAD (48%) followed by RCA (42.9%) and LCx (25.3%) arterial distribution. Mean JCTO score was 1.93 ± 0.7. PCI as a management strategy was adopted in 456 of 1968 patients (23.1%) and was successful in 340 of 456 (74.6%) of patients. Almost all CTO PCI were attempted by an antegrade approach only. Increasing age, male sex, CTO in LCx arterial distribution and higher J CTO score were associated with poorer outcome in CTO PCI.ConclusionsCTO’s are commonly encountered during CAG procedures. In patients undergoing CTO PCI, a fair success rate can be achieved in a high volume experienced centre. 相似文献
3.
Simone Budassi MD Carlo Zivelonghi MD Joseph Dens MD PhD Alan J. Bagnall MD PhD Paul Knaapen MD PhD Alexandre Avran MD James C. Spratt MD Simon Walsh MD Benjamin Faurie MD Pierfrancesco Agostoni MD PhD of all the RECHARGE investigators 《Catheterization and cardiovascular interventions》2021,97(1):E51-E60
4.
Anja Øksnes MD Elisabeth Skaar PhD Britt Engan MD Øyvind Bleie PhD Kjetil H. Løland PhD Nadia Taoussi MD Akiko Maheran PhD Tone Merete Norekvål PhD Svein Rotevatn PhD Margaret B. McEntegart PhD 《Catheterization and cardiovascular interventions》2023,102(1):71-79
Background
The anatomical complexity of a chronic total occlusion (CTO) correlates with procedural failure and complication rates. CTO modification after unsuccessful crossing has been associated with subsequent higher technical success rates, but complication rates remain high with this approach. While successful CTO percutaneous coronary intervention (PCI) has been associated with improved angina and quality of life (QOL) this has not been demonstrated in anatomically high-risk CTOs. Whether a planned CTO modification procedure, hereafter named Investment procedure, could improve patient outcomes has never been investigated.Study Design
Invest-CTO is a prospective, single-arm, international, multicenter study, evaluating the effectiveness and safety of a planned investment procedure, with a subsequent completion CTO PCI (at 8–12 weeks), in anatomically high-risk CTOs. We will enroll 200 patients with CTOs defined as high-risk according to our Invest CTO criteria at centers in Norway and United Kingdom. Patients with aorto-ostial lesions, occlusion within a previous stent, or a prior attempt at target vessel CTO PCI within 6 months will be excluded. The co-primary endpoints are cumulative procedural success (%) after both procedures, and a composite safety endpoint at 30 days after completion CTO PCI. Patient reported outcomes (PROs), treatment satisfaction, and clinical endpoints will be reported.Conclusion
This study will prospectively evaluate the effectiveness and safety of a planned two staged PCI procedure in the treatment of high-risk CTOs and may have the potential to change current clinical practice. 相似文献5.
6.
Maximilian Will MD Konstantin Schwarz MD PhD Thomas Weiss MD PhD Gregor Leibundgut MD Gudrun Lamm MD Paul Vock MD MSc Julia Mascherbauer MD Chun Shing Kwok MD MSc PhD 《Catheterization and cardiovascular interventions》2023,101(4):806-812
Coronary artery disease (CAD) is frequently encountered in patients evaluated for transcatheter aortic valve replacement (TAVR) due to severe aortic stenosis. The prognostic relevance of chronic total occlusions (CTOs) in this setting is poorly understood. We conducted a search of MEDLINE and EMBASE to identify studies evaluating patients who underwent TAVR and evaluated outcomes depending on the presence of coronary CTOs. Pooled analysis was performed to estimate the rate and risk ratio for mortality. Four studies involving 25,432 patients fulfilled the inclusion criteria. The follow up ranged from in-hospital outcomes to 8-years follow-up. Coronary artery disease was present in 67.8% to 75.5% of patients in 3 studies which reported this variable. The prevalence of CTOs varied between 2% and 12.6% in this cohort. The presence of CTOs was associated with increase in length of stay (8.1 ± 8.2 vs. 5.9 ± 6.5, p < 0.01), cardiogenic shock (5.1% vs. 1.7%, p < 0.01), acute myocardial infarction (5.8% vs. 2.8%, p = 0.02) and acute kidney injury (18.6% vs. 13.9%, p = 0.048). The pooled 1-year death rate revealed 41 deaths in 165 patients in the CTO group and 396 deaths in 1663 patients with no CTO ((24.8%) vs. (23.8%)). The meta-analysis of death with CTO versus no CTO showed a nonsignificant trend toward increased mortality with CTOs (risk ratio 1.11 95% CI 0.90–1.40, I2 = 0%). Our analysis suggests that concomitant CTO lesions in patients undergoing TAVR are common, and its presence was associated with increased in-hospital complications. However, CTO presence by itself was not associated with increased long-term mortality, only a nonsignificant trend toward an increased risk of death in patients with CTO was found. Further studies are warranted to assess the prognostic relevance of CTO lesion in TAVR patients. 相似文献
7.
Prognostic value of the age,creatinine, and ejection fraction score for non‐infarct‐related chronic total occlusion revascularization after primary percutaneous intervention in acute ST‐elevation myocardial infarction patients: A retrospective study
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Jie Deng Xiaozeng Wang Yana Shi Xin Zhao Yaling Han 《Journal of interventional cardiology》2018,31(1):33-40
Objective
It is not known if ACEF scores could evaluate the prognosis of recanalization of non‐infarct‐related coronary arteries (non‐IRA) with chronic total occlusions (CTO) in patients who successfully underwent primary PCI. The objective of the current study was to assess the prognostic value of ACEF scores in acute ST‐segment elevation myocardial infarction (STEMI) patients with non‐IRA CTO after successful primary PCI.Methods
There were 2952 STEMI patients who underwent successful primary PCI from January 2006 to December 2014 in our hospital, among them 377 patients had a non‐IRA CTO lesion. The patients were divided into successful CTO‐PCI group (n = 221) and failed/non‐attempted CTO‐PCI group (n = 156). Patients were stratified based on the ACEF tertiles. Primary end points measured in the current study were major adverse cardiac events (MACE) defined as the composite of all‐cause death, nonfatal myocardial infarction, ischemia‐driven coronary revascularization and hospitalization for heart failure at 1 year.Results
The incidence of MACE, all‐cause death and cardiac death were higher in the failed/non‐attempted CTO‐PCI group (P < 0.001). In the successful CTO‐PCI group, the cumulative 1‐year incidences of MACE and all‐cause death were decreased compared to those in the failed/non‐attempted CTO‐PCI group (log‐rank P < 0.001). The risk for MACE was reduced in the successful CTO‐PCI group compared to the failed/non‐attempted CTO‐PCI group in patients with low and intermediate ACEF scores (log‐rank P = 0.02).Conclusions
Successfully staged CTO‐PCI could gain advantageous clinical outcomes in those patients with low or intermediate ACEF scores. 相似文献8.
Imaging behind occluded areas with an iatrogenic perforated balloon: A safe,practical, and simple new method of visualizing the distal lumen in total occlusion
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Yakup Balaban MD Osman Bektaş MD Adil Bayramoğlu MD Hasan A. Gümrükçüoğlu MD Ali H. Kayışoğlu MD 《Journal of interventional cardiology》2017,30(6):544-549
Objective
In the present study, we investigated the effectiveness and reliability of a new method that reveals whether guidewire advanced distal to the lesion is in the lumen in patients with acute (ATO) or chronic coronary total occlusion (CTO).Methods
Forty‐one patients with symptomatic ATO and 22 patients with CTO who were admitted into our catheterization laboratory between January 2016 and March 2017 were included. In patients in whom antegrade filling could not be demonstrated after passing 0.014″ guidewire beyond the total lesion, a 1.25 × 15 mm balloon was punctured with a needle outside the operative field to visualize the total lesion. This perforated balloon was then used to deliver an opaque substance through this hole to visualize the distal part.Results
The mean age of our 63 patients was 66 ± 12 years. They had diabetes (57%), hypertension (100%), and a history of PCI (85%). The mean procedural time was 27 ± 6.8 min, and the mean volume of contrast material used was 93.9 ± 24 mL. This technique was 100% successful in accurately demonstrating the distal lumen and preventing complications.Conclusion
This new method we developed is much simpler and more useful than other methods for visualization of the true lumen because we can re‐orient the balloon at the time of opaque injection and use 190 cm guidewire without additional costs. Additionally, one balloon is sufficient for the operation.9.
James Sapontis MBBCh Taishi Hirai MD Christian Patterson MS Benjamin Gans BS Robert W. Yeh MD MSc William Lombardi MD Dimitri Karmpaliotis MD Jeffrey Moses MD William J. Nicholson MD Ashish Pershad MD R. Michael Wyman MD Anthony Spaedy MD Stephen Cook MD Parag Doshi MD Robert Federici MD Craig A. Thompson MD Karen Nugent RRT Kensey Gosch MS J. Aaron Grantham MD Adam C. Salisbury MD MSc 《Catheterization and cardiovascular interventions》2021,98(4):626-635
10.
Peter Tajti M. Nicholas Burke Dimitri Karmpaliotis Khaldoon Alaswad Gerald S. Werner Lorenzo Azzalini Mauro Carlino Mitul Patel Kambis Mashayekhi Mohaned Egred Oleg Krestyaninov Dmitrii Khelimskii William J. Nicholson Imre Ungi Alfredo R. Galassi Subhash Banerjee Emmanouil S. Brilakis 《JACC: Cardiovascular Interventions》2018,11(7):615-625
Percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) has been rapidly evolving during recent years. With improvement in equipment and techniques, high success rates can be achieved at experienced centers, although overall success rates remain low. Prospective, randomized-controlled data regarding optimal use and indications for CTO PCI remain limited. CTO PCI should be performed when the anticipated benefit exceeds the potential risk. New high-quality studies of the clinical outcomes and techniques of CTO PCI are needed, as is the expansion of expert centers and operators that can achieve excellent clinical outcomes in this challenging patient and lesion subgroup. In the current review the authors summarize the latest publications in CTO PCI and provide an overview of the current state of the field. 相似文献
11.
12.
Xiaodong Qian Haoze Deng Jiamin Yuan Junting Hu Lujia Dai Tingbo Jiang 《Journal of thoracic disease》2022,14(4):1183
BackgroundMany studies have reported potential benefits of percutaneous coronary intervention (PCI) versus optimal drug therapy (ODT) for patients with stable coronary heart disease but with inconsistent results. To examine this, an explicit systematic review and meta-analysis was conducted to compared the clinical outcomes of PCI and ODT in these patients.MethodsThe following terms were combined to search relative articles through databases PubMed, Cochrane Central Register of Controlled Trials, Embase, and Web of Science published from January 2010 to November 2021 according to Participants, Intervention, Control, Outcomes, Study (PICOS) criteria: “coronary heart disease”, “stable coronary heart disease”, “stable angina pectoris”, “percutaneous coronary intervention”, “PCI”, “percutaneous transluminal coronary angioplasty”, “drug therapy”, “optimized drug treatment”, and “optimized drug therapy”. The meta-analysis was performed by RevMan 5.2, and the Cochrane risk of bias tool was used to evaluate the quality of the included studies.ResultsA total of 12 articles were included in the final analysis. There were 4,288 cases of PCI patients and 4,261 cases of ODT patients. The results showed that, when comparing PCI with ODT, there was a significant difference in the probability of myocardial infarction [relative risk (RR) =0.63; 95% confidence intervals (CI): 0.45–0.90] and the patient mortality (RR =0.51; 95% CI: 0.40–0.64). However, there was no significant difference in the prevalence of stroke (RR =1.33; 95% CI: 0.82–2.17), revascularization (RR =0.86; 95% CI: 0.46–1.62) and patient quality of life (MD =10.44; 95% CI: −1.84 to 22.73). Performance bias and detection bias were all unclear in the included studies and should be warned.DiscussionCompared with ODT, PCI reduced the mortality and myocardial infarction rate of patients with CTO or severe coronary artery stenosis. However, the incidence of stroke, revascularization, and quality of life of patients were not significant different between PCI and ODT. Performance bias and detection bias should be cautioned. 相似文献
13.
David E. Kandzari Dimitri Karmpaliotis Annapoorna S. Kini Jeffrey W. Moses Pradyumna E. Tummala J. Aaron Grantham Charles Orr William Lombardi William J. Nicholson Nicholas J. Lembo Jeffrey J. Popma Jin Wang Weiying Zhao Robert McGreevy 《Catheterization and cardiovascular interventions》2019,94(4):509-515
14.
Judit Karacsonyi Peter Tajti Bavana V. Rangan Sean C. Halligan Raymond H. Allen William J. Nicholson James E. Harvey Anthony J. Spaedy Farouc A. Jaffer J. Aaron Grantham Adam Salisbury Anthony J. Hart David M. Safley William L. Lombardi Ravi Hira Creighton Don James M. McCabe M. Nicholas Burke Emmanouil S. Brilakis 《JACC: Cardiovascular Interventions》2018,11(3):225-233
Objectives
The authors performed a multicenter, randomized-controlled, clinical trial comparing upfront use of the CrossBoss catheter versus antegrade wire escalation for antegrade crossing of coronary chronic total occlusions.Background
There is equipoise about the optimal initial strategy for crossing coronary chronic total occlusions.Methods
The primary endpoints were the time required to cross the chronic total occlusion or abort the procedure and the frequency of procedural major adverse cardiovascular events. The secondary endpoints were technical and procedural success, total procedure time, fluoroscopy time required to cross and total fluoroscopy time, total air kerma radiation dose, total contrast volume, and equipment use.Results
Between 2015 and 2017, 246 patients were randomized to the CrossBoss catheter (n = 122) or wire escalation (n = 124) at 11 U.S. centers. The baseline clinical and angiographic characteristics of the study groups were similar. Technical and procedural success were 87.8% and 84.1%, respectively, and were similar in the 2 groups. Crossing time was similar: 56 min (interquartile range: 33 to 93 min) in the CrossBoss group and 66 min (interquartile range: 36 to 105 min) in the wire escalation group (p = 0.323), as was as the incidence of procedural major adverse cardiovascular events (3.28% vs. 4.03%; p = 1.000). There were no significant differences in the secondary study endpoints.Conclusions
As compared with wire escalation, upfront use of the CrossBoss catheter for antegrade crossing of coronary chronic total occlusions was associated with similar crossing time, similar success and complication rates, and similar equipment use and cost. 相似文献15.
Peter Tajti Khaldoon Alaswad Dimitri Karmpaliotis Farouc A. Jaffer Robert W. Yeh Mitul Patel Ehtisham Mahmud James W. Choi M. Nicholas Burke Anthony H. Doing Phil Dattilo Catalin Toma A.J. Conrad Smith Barry F. Uretsky Elizabeth Holper Srinivasa Potluri R. Michael Wyman David E. Kandzari Emmanouil S. Brilakis 《JACC: Cardiovascular Interventions》2019,12(4):346-358
Objectives
This study examined the frequency and outcomes of radial access for chronic total occlusion (CTO) percutaneous coronary intervention (PCI).Background
Radial access improves the safety of PCI, but its role in CTO PCI remains controversial.Methods
We compared the clinical, angiographic, and procedural characteristics of 3,790 CTO interventions performed between 2012 and 2018 via radial-only access (RA) (n = 747) radial-femoral access (RFA) (n = 844) and femoral-only access (n = 2,199) access at 23 centers in the United States, Europe, and Russia.Results
Patients’ mean age was 65 ± 10 years, and 85% were men. Transradial access (RA and RFA) was used in 42% of CTO interventions and significantly increased over time from 11% in 2012 to 67% in 2018 (p < 0.001). RA patients were younger (age 62 ± 10 years vs. 64 ± 10 years and 65 ± 10 years; p < 0.001), less likely to have undergone prior coronary artery bypass graft surgery (18% vs. 39% and 35%; p < 0.001), and less likely to have undergone prior PCI (60% vs. 63% and 66%; p = 0.005) compared with those who underwent RFA and femoral-only access PCI. RA CTO PCI lesions had lower J-CTO (Multicenter CTO Registry in Japan) (2.1 ± 1.4 vs. 2.6 ± 1.3 and 2.5 ± 1.3; p < 0.001) and PROGRESS CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) complication (2.3 ± 1.9 vs. 3.2 ± 2.0 and 3.2 ± 1.9; p < 0.001) scores. The mean sheath size was significantly smaller in the RA group (6.6 ± 0.7 vs. 7.0 ± 0.6 and 7.3 ± 0.8; p < 0.0001), although it increased with lesion complexity. Antegrade dissection re-entry (20% vs. 33% and 32%; p < 0.001) was less commonly used with RA, whereas use of retrograde techniques was highest with RFA (47%). The overall rates of technical success (89% vs. 88% vs. 86%; p = 0.061), procedural success (86% vs. 85% vs. 85%; p = 0.528), and in-hospital major complication (2.47% vs. 3.40% vs. 2.18%; p = 0.830) were similar in all 3 groups, whereas major bleeding was lower in the RA group (0.55% vs. 1.94% and 0.88%; p = 0.013).Conclusions
Transradial access is increasingly being used for CTO PCI and is associated with similar technical and procedural success and lower major bleeding rates compared with femoral-only access interventions. (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention [PROGRESS CTO]; NCT02061436) 相似文献16.
Gunnar Tepe Antonio Micari Koen Keirse Thomas Zeller Dierk Scheinert Pei Li Randy Schmahl Michael R. Jaff 《JACC: Cardiovascular Interventions》2019,12(5):484-493
Objectives
This study evaluated the 12-month safety and effectiveness of a paclitaxel drug-coated balloon for treatment of intermittent claudication or rest pain in subjects with femoropopliteal chronic total occlusions (CTO).Background
CTOs are difficult to treat, and the optimal intervention remains to be determined.Methods
The IN.PACT Global Study is an international single-arm study that enrolled 1,535 patients with symptomatic femoropopliteal artery disease. The study contains prospectively defined cohorts with prospectively planned imaging analyses, including a CTO (≥5 cm) cohort in which subjects underwent duplex ultrasonography analyzed by an independent core laboratory. The primary safety endpoint was a composite of freedom from device- and procedure-related mortality through 30 days, and freedom from major target limb amputation and target vessel revascularization through 12 months. An independent Clinical Events Committee adjudicated all adverse events. The primary effectiveness endpoint was primary patency at 12 months, defined as freedom from clinically driven target lesion revascularization and freedom from restenosis.Results
The CTO imaging cohort had 126 subjects with 127 lesions (mean lesion length 22.83 ± 9.76 cm). Primary patency by Kaplan-Meier estimate was 85.3% through 12 months. Provisional stenting was performed in 46.8% of lesions. The primary safety composite endpoint was achieved by 88.7% of subjects. There were no device- or procedure-related deaths through 30 days or major target limb amputations through 12 months.Conclusions
The paclitaxel drug-coated balloon was safe and highly effective at 12 months after treatment of subjects with CTO ≥5 cm in the femoropopliteal arteries. (IN.PACT Global Clinical Study; NCT01609296) 相似文献17.
Ovidio de Filippo MD Francesco Bruno MD Tineke H. Pinxterhuis MD Mariusz Gąsior MD Leor Perl MD Luca Gaido MD Domenico Tuttolomondo MD Antonio Greco MD Roberto Verardi MD Gianluca Lo Martire MD Mario Iannaccone MD Attilio Leone MD Gaetano Liccardo MD Serena Caglioni MD Rocio González Ferreiro MD Giulio Rodinò MD Giuseppe Musumeci MD Giuseppe Patti MD Irene Borzillo MD Giuseppe Tarantini MD PhD Wojciech Wańha MD Bruno Casella PhD Eline H. Ploumen MD PhD Łukasz Pyka PhD Ran Kornowski MD Andrea Gagnor MD Raffaele Piccolo MD PhD Sergio Raposeiras Roubin MD PhD Davide Capodanno MD PhD Paolo Zocca MD PhD Federico Conrotto MD Gaetano M. De Ferrari MD Clemens von Birgelen MD PhD Fabrizio D'Ascenzo MD PhD ULTRA Collaborators 《Catheterization and cardiovascular interventions》2023,102(2):221-232
18.
Takamasa Tanaka Atsunori Okamura Katsuomi Iwakura Mutsumi Iwamoto Hiroyuki Nagai Tomohiro Yamasaki Akinori Sumiyoshi Kota Tanaka Koichi Inoue Yasushi Koyama Tohru Masuyama Masaharu Ishihara Kenshi Fujii 《JACC: Cardiovascular Interventions》2019,12(6):545-555
Objectives
This study sought to compare the procedural outcomes of percutaneous coronary intervention for chronic total occlusion between the periods before and after introduction of 3-dimensional (3D) wiring.Background
Previously, we reported a 3D wiring method by which the operator can construct real-time mental 3D images from 2 perpendicular angles of X-ray system monitor during percutaneous coronary intervention for chronic total occlusion.Methods
A total of 137 chronic total occlusion lesions that could not be passed by tapered soft wires in our hospital between 2012 and 2017 were retrospectively enrolled in the study.Results
Overall success rate was significantly higher in the 3D wiring group (n = 69) than the non-3D wiring group (n = 68) (98% vs. 90%, respectively; p = 0.027). In the primary antegrade cases, the first antegrade approach time was significantly shorter in the 3D wiring group than the non-3D wiring group (42 ± 29 vs. 30 ± 16 min, respectively; p = 0.01). In cases where the antegrade approach was continued throughout the procedure, the success rate was significantly higher in the 3D wiring group than the non-3D wiring group (100% vs. 89.2%, respectively; p = 0.033). Vessel perforation by the antegrade wire tended to be lower in the 3D wiring group than the non-3D wiring group (1% vs. 11%, respectively; p = 0.055).Conclusions
3D wiring enables accurate guidewire control, which improves the success rate of antegrade wiring and reduces the antegrade procedure time, resulting in improvement of the overall success rate. 相似文献19.
Kashyap B Patel Himanshu Gupta Hrudaya Nath Raed A Aqel Gilbert J Zoghbi Benigno Soto Gilbert J Perry Steven G Lloyd 《Catheterization and cardiovascular interventions》2007,69(5):711-718
OBJECTIVE: We sought to determine the incidence and imaging features by coronary angiography and cardiac magnetic resonance imaging (MRI) of anomalies in which the right, circumflex, and left anterior descending coronary arteries arise separately from the right sinus of Valsalva. BACKGROUND: The anomalous origin of all major coronary arteries from separate ostia in the right sinus of Valsalva has been reported as exceedingly rare, with mainly isolated cases reported. A knowledge of the origin and proximal courses of aberrant arteries is critical for patient management. METHODS: 42 consecutive patients without other congenital heart disease referred to our institution for MRI evaluation of anomalous coronary artery over a six year period were evaluated. Analysis of angiograms and MRI was done to determine the anatomic origin and proximal pathway of coronary arteries (determined by conventional angiography and MRI) and degree of any stenosis (by angiography). RESULTS: Seven of the 42 patients (17%) in this referral population had the described anatomy. Both conventional angiography and MRI depicted the origin and proximal courses of these arteries. In all patients, the circumflex passed behind the aorta. In three, the left anterior descending passed through the ventricular septum; in four, it passed anterior to the pulmonary trunk. CONCLUSIONS: This series is the largest ever reported on this complex anatomical variant and the first to give a systematic analysis of the anatomy by angiography and MRI. This constellation of multiple anomalous coronary arterial origins and proximal courses may not be as rare as previously reported. 相似文献