Interventional Cardiology. Группа авторов
– not recommended; + occasionally useful; ++ very useful; +++ ideal.
AP, anteroposterior; LAD, left anterior descending; LAO, left anterior oblique; LCX, left circumflex; LIMA, left internal mammary artery; OM, obtuse marginal; PDA, posterior descending artery; PLV, posterior left ventricular; RAO, right anterior oblique; RCA, right coronary artery.
Table 4.2 Popular view combinations for diagnostic angiography with benefits and limitations of each view.
| View | Good for visualizing | Limitations |
|---|---|---|
| Combination 1 | ||
| AP (5–10° RAO) | LMS (ostium and main shaft) | Overlap on LMS bifurcation and sometimes LMS ostium with left coronary sinus |
| Lateral | Mid and distal LAD, mid Cx | Potentially high radiation dose to operator, usually limited view of proximal LAD, patient’s arms need to be above head to visualize posterior arteries, often overlap diagonals/LAD |
| RAO cranial | Proximal and mid LAD, distal Cx | Test injections can be required to adjust angulation to ensure diagonals are above LAD, overlap with dominant Cx, and position of the diaphragm |
| RAO caudal | Circumflex and distal LAD | |
| Combination 2 | ||
| LAO caudal | LMS bifurcation, proximal LAD and proximal circumflex | Potentially a higher radiation dose to the patient, poor quality images sometimes in large patients |
| LAO cranial | Mid LAD, origin of diagonals, proximal and mid Cx | Patient required to hold in inspiration during acquisition to elongate the proximal LAD |
| AP cranial | Proximal and mid LAD, distal Cx | Steep cranial angulation required can be a problem for patients with cervical spine fixation |
| RAO caudal | Circumflex and distal LAD, sometimes LAD ostium |
AP, anteroposterior; Cx, circumflex; LAD, left anterior descending; LAO, left anterior oblique; LMS, left main stem; RAO, right anterior oblique.
Right‐sided views
Two perpendicular views are advocated for the RCA, usually LAO and right anterior oblique (RAO). However, it is frequently impossible to exclude disease at or beyond the crux without an additional view with cranial angulation (e.g. PA cranial or LAO cranial).
Lesion‐specific approach
Optimal views for each coronary segment
Views that reliably demonstrate the full length of each coronary segment while minimizing foreshortening and overlap