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Left anterior descending artery length in left and right coronary artery dominance

Ilia, Reuben ; Rosenshtein, Gabriel ; Marc Weinstein, Jean ; Cafri, Carlos ; Abu-Ful, Akram ; Gueron, Mosche

Features: Rapid Communication

Background Coronary stenosis of the left anterior descending artery (LAD) is respected by cardiologists because of its negative influence on morbidity and mortality. An important anatomical consideration is the length of the LAD.

Objective To investigate the relationship between length of LAD and coronary dominance.

Design Retrospective comparison of 100 consecutive angiograms with left coronary dominance with 100 consecutive angiograms with right coronary dominance. The relationship between the length of the LAD and coronary dominance was analyzed.

Methods We retrospectively compared 100 consecutive angiograms with left coronary dominance (the posterior descending artery being supplied by the circumflex artery) with 100 consecutive angiograms with right coronary dominance (the posterior descending artery being supplied by the right coronary artery). LADs were categorized into three types: type A, LAD terminating before the cardiac apex; type B, LAD reaching the apex but not supplying the inferoapical segment of the left ventricle; and type C, LAD wrapping around the apex and supplying the inferoapical segment. LAD typing was also analyzed in relation to gender.

Results It was found that the LAD wrapped around the apex in 87% of cases of left coronary dominance but only in 47% of patients with right coronary dominance, and that the long LADs were more frequently seen in women than in men, irrespective of coronary dominance.

Conclusions We found that the LAD in left coronary dominance is usually long and wraps around the apex, and believe that angiographic interventions in such cases have important clinical significance.

Cardiology Department, Soroka Medical Center and Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel

Correspondence and requests for reprints to Reuben Ilia, MD, Cardiology Department, Soroka Medical Center, Beer Sheva, Israel 84105. Fax: +972 7 623 8248; e-mail: iliar@bgumail.bgu.ac.il

Received 8 August 2000

Accepted 11 August 2000

© 2001 Lippincott Williams & Wilkins, Inc.