Coronary angiography right coronary artery

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Coronary Angiography


General Principles

Historical Perspective
Appropriate Use Criteria for Revascularization
Film Quality

Anatomy & Projection Angles

Normal Anatomy

Coronary arteries
Right System
Left System
Left Main
Left Anterior Descending
Median Ramus

Anatomic Variants

Separate Ostia
Anomalous Origins
Case Example

Projection Angles

Standard Views
Left Coronary Artery
Right Coronary Artery

Epicardial Flow & Myocardial Perfusion

Epicardial Flow

TIMI Frame Count
TIMI Flow Grade
TIMI Grade 0 Flow
TIMI Grade 1 Flow
TIMI Grade 2 Flow
TIMI Grade 3 Flow
TIMI Grade 4 Flow
Pulsatile Flow

Myocardial Perfusion

TIMI Myocardial Perfusion Grade
TMP Grade 0
TMP Grade 0.5
TMP Grade 1
TMP Grade 2
TMP Grade 3

Lesion Complexity

ACC/AHA Lesion-Specific Classification of the Primary Target Stenosis

Preprocedural Lesion Morphology

Intimal Flap
Sawtooth Pattern
Ostial location
Proximal tortuosity
Degenerated SVG
Total occlusion
Coronary Artery Thrombus
TIMI Thrombus Grade
TIMI Thrombus Grade 0
TIMI Thrombus Grade 1
TIMI Thrombus Grade 2
TIMI Thrombus Grade 3
TIMI Thrombus Grade 4
TIMI Thrombus Grade 5
TIMI Thrombus Grade 6

Lesion Morphology

Quantitative Coronary Angiography
Definitions of Preprocedural Lesion Morphology
Irregular Lesion
Disease Extent
Arterial Foreshortening
Infarct Related Artery
Degenerated SVG

Left ventriculography

Quantification of LV Function
Quantification of Mitral Regurgitation

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]


The right coronary artery (RCA) is a coronary artery with a single origin near the right semilunar cusp of the aortic valve that bifurcates (branches) to supply the right ventricular free wall through the acute marginal branches), the inferior wall of the left ventricle through the posterior descending artery, and the posterolateral wall of the left ventricle via the right posterolateral branch. On coronary angiography, the RCA is easily recognizable as it appears like the letter C in the left anterior oblique (LAO) projection and appears like a letter L in the right anterior oblique (RAO) projection. There are three angiographic views of the RCA that are traditionally obtained to visualize the proximal, middle, and distal segments.

How to Engage the Right Coronary Artery

The right coronary artery (RCA) is engaged in the 30° LAO position. Using the femoral arterial approach, a Judkins Right 4 (JR4) catheter is traditionally used to engage the right coronary artery. The JR4 catheter is advanced into the body to make contact with the aortic valve. Next, the operator gently pulls the catheter out of the body about 2 cm while torquing the catheter clockwise. When the catheter faces to the left on the screen, it should be in or near the ostium of the right coronary artery. Other catheters that can be used to engage the right coronary artery include the Amplatz Right (AR1) and Amplatz Left (AL2 and AL3) catheters. If the origin of the right coronary artery has an upward trajectory, an internal mammary artery catheter may engage better. An inferiorly directed ostium may be cannulated with either a right coronary bypass catheter or an Amplatz catheter.

Optimal Views of the Right Coronary Artery

The following sequence of 3 traditional views is obtained as the gantry is swung from the 30° LAO straight position to the AP 15° cranial position to the 30° RAO striaght position.

Proximal RCA

The Proximal RCA (R1 segment) including the ostium is best visualized in the 30° LAO view with no cranial or caudal angulation.

RCA 30 LAO.png
RCA 30 LAO.gif

R1 = Proximal right coronary artery; R2 = Middle right coronary artery; R3 = Distal right coronary artery; RPDA = Right posterior descending artery.

Bifurcation of the RCA

The camera is next swung cranially to 15° - 20° and the LAO angulation is minimized to 5° - 10°. This view optimizes the bifurcation of the distal RCA where the right posterolateral artery and the posterior descending artery divide and branch from the distal right coronary artery. The patient should take a deep breath and hold it during the injection to optimize the view.

RCA 5 LAO 15 CRA.png
RCA 5 LAO 15 CRA.gif

R1 = Proximal right coronary artery; R2 = Middle right coronary artery; R3 = Distal right coronary artery; RPDA = Right posterior descending artery.


The middle RCA (R2 segment) is best visualized in the 30° RAO straight view.

RCA 30 RAO.png
RCA 30 RAO .gif

R1 = Proximal right coronary artery; R2 = Middle right coronary artery; R3 = Distal right coronary artery; RPDA = Right posterior descending artery.

Additional Images


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