Diagnosis, risk assessment, and surgical planning of coronary artery anomalies by CT angiography

Overview

This retrospective analysis evaluates coronary computed tomography angiography (CCTA) as a diagnostic and surgical planning modality for coronary artery anomalies across a cohort spanning five years. The study characterizes the imaging findings, prevalence patterns, and demographic variations in a population of 2,786 patients, of which 53 exhibited coronary artery anomalies. Classification encompassed origin, course, and structural morphology, with examination conducted via dual-source CT technology.

Methods and approach

A retrospective cohort analysis examined 2,786 consecutive patients who underwent CCTA between November 2018 and October 2023. Cases were stratified by the presence of coronary artery anomalies, yielding 53 subjects (21 female, 32 male). Anomalies were systematically classified according to origin characteristics, course trajectory, and structural features. Imaging acquisition employed dual-source CT scanner technology. Demographic comparisons and gender-stratified analyses were performed to identify variation patterns in anomaly presentation and course characteristics.

Results

Coronary artery anomalies occurred in 1.82% of the examined population (53 of 2,786 patients). The predominant anomaly was high take-off origin of the right coronary artery, accounting for 41.5% of cases. Left main anomalies demonstrated increased frequency in males, whereas malignant courses were identified exclusively in females, representing 19% of the female subgroup. Ancillary findings included coronary stenosis and coronary diverticula. Three-dimensional visualization provided by CCTA facilitated detailed anatomic characterization relevant to preoperative planning.

Implications

Coronary CT angiography functions as a non-invasive diagnostic tool for identifying and characterizing coronary artery anomalies with sufficient anatomic detail to support surgical planning and risk stratification. The modality provides three-dimensional reconstruction capabilities that surpass conventional angiographic assessment in depicting anomalous courses and relationships to adjacent structures. The ability to perform comprehensive preoperative evaluation may contribute to improved outcomes in surgical and interventional management decisions.

The study documents clinically significant demographic variation in anomaly presentation and course characteristics, with gender-specific differences in malignant course prevalence. These findings suggest that patient demographic factors warrant consideration in diagnostic protocols and clinical management strategies. The exclusively female distribution of malignant courses in this cohort, despite male predominance in overall anomaly prevalence, underscores the importance of comprehensive imaging evaluation across all demographic groups.

Implementation of standardized protocols for CCTA acquisition and interpretation of coronary artery anomalies would facilitate multicenter comparison and optimization of diagnostic accuracy. Further prospective investigation with larger, multicenter datasets would strengthen the evidence base for risk stratification algorithms and outcome prediction in this population, particularly regarding the clinical significance of demographic variations in anomaly presentation and course characteristics.