Three-dimensional coronary imaging for the ostium of the left anterior descending artery

  • Kenji SadamatsuEmail author
  • Shuichiro Sagara
  • Tohru Yamawaki
  • Hideki Tashiro
Original Paper


Conventional coronary angiography is subject to a significant foreshortening of the proximal left anterior descending artery and overlapping of the left anterior descending artery and the circumflex artery that limits the accurate identification of the ostium of the left anterior descending artery. The aim of this study was to determine whether the three-dimensional (3D) reconstruction of traditional coronary angiography could optimize the projection angle to clearly show the ostium of the left anterior descending artery. The left main bifurcations of 18 consecutive patients were analyzed. A 3D image of the bifurcation was reconstructed from two conventional images and the optimal projection angle was chosen to clearly identify the ostium of the left anterior descending artery. The optimal angle was the right anterior oblique 18.8 ± 20.9°-caudal 26.9 ± 32.3°. The length from the left main trunk to the proximal left anterior descending artery on the optimal views was significantly longer than that on the routine views (25.0 ± 6.1 vs. 22.4 ± 5.3 mm, P = 0.011). The angles of the left main bifurcations were not substantially different between the optimal and the routine views. The optimal views selected using the 3D system provided clearer images of the ostium of the left anterior descending artery with less overlapping and foreshortening.


Coronary angiography Coronary stenosis Three-dimensional imaging Intravascular ultrasound 



Left anterior descending artery


Left circumflex artery






Interventional cardiac three-dimensional


Intravascular ultrasound


Right anterior oblique


Left anterior oblique

Supplementary material

Supplementary material

The movie demonstrates the optimization steps.

A 3D vessel model was reconstructed automatically from 2 conventional angiographic images using the interventional cardiac 3D system. The projection angle of the image of the reconstructed 3D vessel model is shown in the upper right portion of the movie. First of all, we rotated the model to elongate the ostial LAD and to maximize the bifurcation angle. RAO 58-caudal 46 was indicated in the upper right portion of the movie, however, the font color showing the angle turned red, as a result, this angle was not considered to be practical. We therefore rotated the vessel model to the possible angle range, while carefully avoiding any overlapping of the bifurcation and foreshortening of the LAD, as a result, an angle of RAO58-caudal 42 was thus obtained.

3D, three-dimensional; LAD, left anterior descending artery; RAO, right anterior oblique. (MOV 498 kb)


  1. 1.
    Lemos PA, Hoye A, Goedhart D et al (2004) Clinical, angiographic, and procedural predictors of angiographic restenosis after sirolimus-eluting stent implantation in complex patients: an evaluation from the Rapamycin-eluting stent evaluated at Rotterdam Cardiology Hospital (RESEARCH) study. Circulation 109:1366–1370. doi: 10.1161/01.CIR.0000121358.26097.06 PubMedCrossRefGoogle Scholar
  2. 2.
    Lemos PA, Saia F, Ligthart JM et al (2003) Coronary restenosis after sirolimus-eluting stent implantation: morphological description and mechanistic analysis from a consecutive series of cases. Circulation 108:257–260. doi: 10.1161/01.CIR.0000083366.33686.11 PubMedCrossRefGoogle Scholar
  3. 3.
    Green NE, Chen SY, Messenger JC, Groves BM, Carroll JD (2004) Three-dimensional vascular angiography. Curr Probl Cardiol 29:104–142. doi: 10.1016/j.cpcardiol.2004.01.002 PubMedCrossRefGoogle Scholar
  4. 4.
    Schlundt C, Kreft JG, Fuchs F, Achenbach S, Daniel WG, Ludwig J (2006) Three-dimensional on-line reconstruction of coronary bifurcated lesions to optimize side-branch stenting. Catheter Cardiovasc Interv 68:249–253. doi: 10.1002/ccd.20653 PubMedCrossRefGoogle Scholar
  5. 5.
    Gradaus R, Mathies K, Breithardt G, Bocker D (2006) Clinical assessment of a new real time 3D quantitative coronary angiography system: evaluation in stented vessel segments. Catheter Cardiovasc Interv 68:44–49. doi: 10.1002/ccd.20775 PubMedCrossRefGoogle Scholar
  6. 6.
    Gollapudi RR, Valencia R, Lee SS, Wong GB, Teirstein PS, Price MJ (2007) Utility of three-dimensional reconstruction of coronary angiography to guide percutaneous coronary intervention. Catheter Cardiovasc Interv 69:479–482. doi: 10.1002/ccd.20955 PubMedCrossRefGoogle Scholar
  7. 7.
    Dvir D, Marom H, Guetta V, Kornowski R (2005) Three-dimensional coronary reconstruction from routine single-plane coronary angiograms: in vivo quantitative validation. Int J Cardiovasc Intervent 7:141–145PubMedGoogle Scholar
  8. 8.
    Medina A, de Lezo JS, Pan M (2006) A new classification of coronary bifurcation lesions. Rev Esp Cardiol 59:183. doi: 10.1157/13084649 PubMedCrossRefGoogle Scholar
  9. 9.
    Green NE, Chen SY, Hansgen AR, Messenger JC, Groves BM, Carroll JD (2005) Angiographic views used for percutaneous coronary interventions: a three-dimensional analysis of physician-determined vs. computer-generated views. Catheter Cardiovasc Interv 64:451–459. doi: 10.1002/ccd.20331 PubMedCrossRefGoogle Scholar
  10. 10.
    Dvir D, Marom H, Assali A, Kornowski R (2007) Bifurcation lesions in the coronary arteries: early experience with a novel 3-dimensional imaging and quantitative analysis before and after stenting. EuroIntervention 3:95–99Google Scholar
  11. 11.
    Tsagalou E, Stankovic G, Iakovou I et al (2006) Early outcome of treatment of ostial de novo left anterior descending coronary artery lesions with drug-eluting stents. Am J Cardiol 97:187–191. doi: 10.1016/j.amjcard.2005.07.131 PubMedCrossRefGoogle Scholar
  12. 12.
    Park SJ, Lee CW, Hong MK, Kim JJ, Park SW (2000) Stent placement for ostial left anterior descending coronary artery stenosis: acute and long-term (2-year) results. Catheter Cardiovasc Interv 49:267–271. doi:10.1002/(SICI)1522-726X(200003)49:3<267::AID-CCD9>3.0.CO;2-HPubMedCrossRefGoogle Scholar
  13. 13.
    Tobis J, Azarbal B, Slavin L (2007) Assessment of intermediate severity coronary lesions in the catheterization laboratory. J Am Coll Cardiol 49:839–848. doi: 10.1016/j.jacc.2006.10.055 PubMedCrossRefGoogle Scholar
  14. 14.
    Hecht HS, Roubin G (2007) Usefulness of computed tomographic angiography guided percutaneous coronary intervention. Am J Cardiol 99:871–875. doi: 10.1016/j.amjcard.2006.10.049 PubMedCrossRefGoogle Scholar
  15. 15.
    Otsuka M, Sugahara S, Nakamura M et al (2007) Optimal fluoroscopic view selection for percutaneous coronary intervention by multislice computed tomography. Int J Cardiol 118:e94–e96. doi: 10.1016/j.ijcard.2007.01.045 PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, B.V. 2008

Authors and Affiliations

  • Kenji Sadamatsu
    • 1
    • 2
    Email author
  • Shuichiro Sagara
    • 1
  • Tohru Yamawaki
    • 1
  • Hideki Tashiro
    • 1
  1. 1.Department of CardiologySt. Mary’s HospitalKurumeJapan
  2. 2.Department of CardiologySaga Prefectural Hospital KoseikanSagaJapan

Personalised recommendations