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Assessment of lateral costal artery with CT angiography: determination of prevalence and vessel length in the general population and its potential impact for coronary artery bypass grafting

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Abstract

Objectives

Standard treatment for severe coronary artery disease (CAD) is coronary artery bypass grafting (CABG). An underreported branch of the internal mammary artery, the lateral costal artery (LCA), can cause a steal phenomenon after CABG, resulting in angina. The aim of this study was to determine the prevalence and length of LCA based on CT angiography (CTA).

Methods

This retrospective study included adult patients undergoing a thoracic CTA between January 2016 and August 2018. Exclusion criteria were prior CABG, insufficient clinical information, or inadequate image quality. Two blinded, independent readers reviewed all studies for the prevalence of the LCA. Positive cases were reviewed by two readers (R1/R2) for side distribution and vessel length, measured in intercostal spaces (ICS). Study indication, aortic size, and coronary calcification were noted.

Results

LCA was present in up to 42/389 (11%) of studies (60.3 ± 16.7 years, 30 males). The LCA was most commonly unilateral (n = 23, 55%). Median vessel length was 2 ICS (IQR 0; 3). Logistic regression was not significant in vessel distribution for sex (OR 0.6, 95% CI 0.28–1.15; p = 0.11). Inter-observer agreement in detecting LCA was substantial (kappa 0.71, 95% CI 0.59–0.83) and excellent for side/length distribution (kappa 0.94, 95% CI 0.82–1.0; ICC 0.96, 95% CI 0.93–0.98).

Conclusion

The LCA is uncommon and most often unilateral and extends the third rib. Radiologists should be aware of this vessel and its potential role in angina after CABG, particularly when large.

Key Points

• LCA is an uncommon normal variant that is reported to cause angina pectoris after CABG.

• CT angiography can reliably detect the LCA. It is most often unilateral and spans two intercostal spaces.

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Abbreviations

CABG:

Coronary artery bypass grafting

CI:

Confidence interval

CTA:

CT angiography

HU:

Hounsfield unit

ICC:

Intraclass correlation coefficient

IMA:

Internal mammary artery

IQR:

Interquartile range

LAD:

Left anterior descending coronary artery

LCA:

Lateral costal artery

MPR:

Multiplanar reconstructions

OR:

Odds ratio

PCI:

Percutaneous coronary intervention

R:

Reader

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The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Joint Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, 585 University Avenue, Toronto, ON, M5G2 2N2, Canada

    Christian P. Houbois, Gauri Karur, Jennifer Fratesi & Micheal C. McInnis

  2. Department of Diagnostic and Interventional Radiology, University Hospital of Cologne, Cologne, Germany

    Christian P. Houbois

Authors
  1. Christian P. Houbois
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  2. Gauri Karur
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  3. Jennifer Fratesi
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  4. Micheal C. McInnis
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Corresponding author

Correspondence to Christian P. Houbois.

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Guarantor

The scientific guarantor of this publication is Dr. M. McInnis.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.

Methodology

• retrospective

• cross-sectional study

• performed at one institution

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Houbois, C.P., Karur, G., Fratesi, J. et al. Assessment of lateral costal artery with CT angiography: determination of prevalence and vessel length in the general population and its potential impact for coronary artery bypass grafting. Eur Radiol 31, 1941–1946 (2021). https://doi.org/10.1007/s00330-020-07292-9

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  • DOI: https://doi.org/10.1007/s00330-020-07292-9

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