Left anterior descending artery
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The left anterior descending (LAD) artery, also known as the anterior interventricular branch, is one of the two branches of the left coronary artery (the other branch being the circumflex (Cx) artery).
The left anterior descending artery is often given the sobriquet, the widow-maker, particularly by the lay media, due to the propensity for proximal disease of the left anterior descending artery to cause the death of male partners. Although quite clearly women are also killed by disease at this location 6.
It descends along the interventricular groove.
It can be divided into proximal, mid and distal segments and this helps to differentiate the names of its various small branches 1:
- origin: left coronary artery
- branches 4
- proximal: from the origin to the first diagonal branch (D1) (although some authors use the first septal perforator (S1) as the landmark)
- mid: from the origin of D1 to half the distance from the D1 origin to the apex
- distal: distal to half the distance from the D1 origin to the apex
The LAD should arise from the left coronary cusp which lies between 3 and 6 o'clock on an axial view.
The length of the LAD can be highly variable. On angiography, it may be reported as types I-III:
- type I: short vessel (can terminate before apex)
- type II: intermediate vessel
- type III: long wrap-around vessel (around the apex)
The LAD lies in the epicardial fat within the anterior interventricular septum 1:
- inferior: myocardium
- superior: pericardium
- the great cardiac vein ascends in the anterior IV groove with the LAD
The LAD supplies the anterolateral myocardium and apex with one of its branches supplying the anterior two-thirds of the interventricular septum.
dual left anterior descending coronary artery2: two left anterior descending coronary arteries (one usually shorter in length) that are both situated in the anterior interventricular groove
- it is important to know of this variation when planning surgical vascularization 3
- the mid 1/3rd of the LAD is known on occasion to course through the myocardium, known as myocardial bridging; does not have any clinical significance
- occlusion of LAD leading to myocardial infarction or sudden cardiac death
- the LAD is the most commonly occluded of the coronary arteries
- it provides the major blood supply to the interventricular septum, and bundle branches of the conducting system
- blockage of this artery can lead to impairment or death (infarction) of the conducting system
- represents subacute occlusion of the LAD
de Winter's T wave pattern
- indicates acute occlusion of the proximal LAD
- 1. Smuclovisky C. Coronary Artery CTA: A Case-Based Atlas. Springer. ISBN:1441904301. Read it at Google Books - Find it at Amazon
- 2. Bozlar U, Uğurel MŞ, Sarı S et-al. Prevalence of dual left anterior descending artery variations in CT angiography. Diagn Interv Radiol. 2015;21 (1): 34-41. doi:10.5152/dir.2014.14275 - Pubmed citation
- 3. Agarwal PP, Kazerooni EA. Dual left anterior descending coronary artery: CT findings. AJR Am J Roentgenol. 2008;191 (6): 1698-701. doi:10.2214/AJR.08.1193 - Pubmed citation
- 4. Pannu HK, Flohr TG, Corl FM et-al. Current concepts in multi-detector row CT evaluation of the coronary arteries: principles, techniques, and anatomy. Radiographics. 2003;23 Spec No (suppl_1): S111-25. doi:10.1148/rg.23si035514 - Pubmed citation
- 5. O'Brien JP, Srichai MB, Hecht EM et-al. Anatomy of the heart at multidetector CT: what the radiologist needs to know. (2007) Radiographics : a review publication of the Radiological Society of North America, Inc. 27 (6): 1569-82. doi:10.1148/rg.276065747 - Pubmed
- 6. Raja JM, Nanda A, Pour-Ghaz I, Khouzam RN. Is early invasive management as ST elevation myocardial infarction warranted in de Winter's sign?-a "peak" into the widow-maker. (2019) Annals of translational medicine. 7 (17): 412. doi:10.21037/atm.2019.07.19 - Pubmed