CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 4, May 2013
AFRICA
e3
because of the doubt whether the stent had covered the LAD’s
origin, thus potentially preventing selective access in the future.
MSCTplayed a key role in obtaining a complete overviewof the
coronary anatomy because the three-dimensional visualisation of
the coronary arteries permitted us to overcome the angiographic
limitations described above. Indeed, this technique clearly
displayed the congenital coronary artery anomaly because it
showed the LAD and RCA had a very short common origin and,
in addition, allowed a detailed evaluation of the course of the
anomalous vessel, showing its inter-arterial course. Furthermore,
MSCT gave important post-procedural information because it
revealed that the origin of the LAD was not covered by the stent.
Previous studies have demonstrated that congenital anomalies
of the coronary arteries may cause ischaemic manifestations.
12
In
the past, these patients have been extensively treated with surgery,
13
with less-than-ideal long-term results.
14
Therefore, the greater use
of coronary stents for treating atherosclerotic coronary lesions
has progressively increased the use of coronary angioplasty in this
setting.
15
However, several important considerations regarding the
coronary anatomy and technical difficulties of the percutaneous
approach should be evaluated to choose the best method of
revascularisation in patients with these coronary anomalies.
Conclusion
Multi-slice computed tomography may be considered a
fundamental non-invasive technique to study the coronary tree,
especially in those patients with a particular coronary anatomy.
Although it is unlikely that this imaging technique will replace
coronary angiography in assessment for revascularisation of
patients with coronary artery disease, particularly because
angiography and angioplasty are often performed at the same
time, MSCT may allow us to refine angiographic diagnosis by
providing a detailed description of anomalous coronary arteries.
In addition, it may give pivotal information to obtain the best
evaluation of procedural outcomes in the subset of patients
treated with PCI.
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