PTCA OF RCA: Percutaneous transluminal coronary an...

PTCA OF RCA: Percutaneous transluminal coronary angioplasty (PTCA) is a minimally invasive procedure to open up blocked coronary arteries, allowing blood to circulate unobstructed to the heart muscle. In the coronary circulation, the right coronary artery (RCA) is an artery originating above the right cusp of the aortic valve, at the right aortic sinus in the heart. It travels down the right coronary sulcus, towards the crux of the heart. The use of a balloon-tipped catheter to enlarge a narrowed coronary artery. Among the clinical manifestations of ischemic heart disease, right coronary artery (RCA) disease offers a wide variety of right and left ventricular ischemic involvement, including prevalent right ventricular dysfunction and severe cardiac failure. An intraluminal coronary artery stent is a small, self-expanding, stainless steel mesh tube that is placed within a coronary artery to keep the vessel open. It may be used, after balloon angioplasty to prevent reclosure of the blood vessel. ... The scan additionally demonstrates the RCA stent location and patency. When intervention is indicated for anomalous origination of a coronary artery from the opposite sinus, stent-angioplasty may seem more attractive than coronary artery bypass grafting. However, in the case of anomalous origination of a coronary artery from the opposite sinus, the anatomy is quite different from that encountered in atherosclerotic disease, and stent-angioplasty would involve unusual challenges, both in technique and prognostic outcomes. We illustrate these points by presenting the 2 first cases in which intervention was indicated because of severe symptoms. We conclude from this preliminary study that coronary artery bypass grafting should still be considered the preferred (although unproven) method of revascularization in patients who have symptomatic anomalous origination of a coronary artery from the opposite sinus. Until adequate data have been gathered to evaluate the late results of stent-angioplasty in these patients (in comparison with the results of surgical and medical treatment), the procedure should be performed only in selected patients, enrolled in prospective, controlled studies. Some congenital coronary artery anomalies commonly cause ischemic manifestations. Until recently, coronary artery bypass grafting (CABG) was the only alternative to medical treatment in these cases. However, stenting has become an increasingly attractive alternative for managing congenital anomalies that result in vascular stenosis, because of its success in treating atherosclerotic stenoses. For some congenital anomalies, it seems apparent that stent-angioplasty is not advisable. For instance, the occasional use of stents to treat muscular bridges has recently been reported. Nevertheless, our preliminary experience and that of others indicates that this practice should generally be avoided because of the prohibitive rate of restenosis, possibly due to crushing of the stent (as a consequence of phasic compression) or mechanical stimulation. Anomalous origination of a coronary artery from the opposite sinus (ACAOS) is a congenital anomaly that might be presumed to respond favorably to stent-angioplasty. Recently, intravascular ultrasonography (IVUS) imaging at baseline and after testing by pharmacologic provocation has suggested that, in ACAOS, the main mechanism of ischemia originates with the proximal ectopic vessel, which runs intramurally at the aortic root while crossing the aortopulmonary septum. This type of coronary stenosis is usually relatively mild at baseline; only in exceptional cases does it become clinically significant (typically during or after extreme exertion). In such cases, arterial conduits such as a left internal mammary implant tend to develop poorly, and soon occlude in the absence of a favorable hemodynamic regimen (a significant pressure drop beyond the stenotic area in the recipient vessel).