Moderate LAD stenosis on CTCA

Case contributed by Craig Hacking
Diagnosis certain

Presentation

Several weeks of left-sided chest pain. Risk factors: age, ex-smoker, hypertension, hyperlipidemia. Troponin-I negative, Z score negative, ECG normal.

Patient Data

Age: 65 years
Gender: Male

TECHNIQUE:

Prospective, ECG-gated, CT coronary angiogram, following intravenous contrast with bolus tracking. 12 lead ECG performed and reviewed to assess sinus rhythm and normal conduction prior to imaging protocol and acquisition. Examination explained and sublingual GTN and oral rate-limiting agents given.

FINDINGS:

The coronary ostia are anatomically normal. The origins and proximal courses of the coronary arteries are normal.

Right coronary dominance is present.

LMCA: Kinking in the ostial vessel. Eccentric, partially calcified plaque within the distal vessel causes minimal luminal narrowing.

LAD: Noncalcified and partially calcified plaques within the proximal to mid vessel cause moderate stenosis in the proximal to mid vessel. D1: Normal.

Ramus: Noncalcified plaque within the ostial vessel causes mild luminal narrowing.

Circumflex: Eccentric, partially calcified plaque within the proximal vessel causes minimal luminal narrowing. OM1: Normal. OM2: Normal.

RCA: Noncalcified and partially calcified plaques within the proximal to mid vessel cause up to mild luminal narrowing.

PDA: Normal.

PLB: Normal.

Non-coronary cardiac findings:

Atria and ventricles are subjectively normal.

Aortic and mitral valve leaflets appear mildly thickened and irregular.

No left-sided filling defect is identified.

Myocardial clefts noted within the left ventricle.

No pericardial thickening or effusion is identified.

CONCLUSION:

  • Moderate stenosis within the proximal / mid LAD junction at bifurcation of D1.
  • Mild luminal narrowing within the proximal to mid RCA and ostial ramus.
  • Minimal luminal narrowing within the distal left main stem and proximal circumflex.

Case Discussion

CTCA example of moderate stenosis in the LAD at the D1 origin.

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