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A 60-year-old man with hypertension and hyperlipidemia was diagnosed with multivessel coronary artery disease and underwent cardiac catheterization, which revealed significant stenoses in the left main, circumflex, ramus, and right coronary arteries. During the procedure, he developed hypotension and chest pain, requiring intra-aortic balloon pump support and urgent referral for coronary artery bypass grafting.
Coronary angiography, performed using standard catheters (JR4, JL4), relies on multiple projections (right anterior oblique (RAO), left anterior oblique (LAO), cranial, caudal) to visualize coronary anatomy. Understanding how these views represent coronary anatomy—along with using catheter size as a reference—allows for the assessment of vessel size, stenosis severity, and the spatial relationships of coronary branches. This allows for evaluation of bypass targets based on vessel diameter, degree and location of stenosis, distal vessel quality, calcification, and myocardial territory supplied.
The patient underwent successful three-vessel coronary artery bypass grafting (CABG) left internal mammary artery (LIMA) to left anterior descending artery (LAD), radial to ramus, vein graft to posterior descending artery (PDA)) and recovered uneventfully. This highlights the importance of detailed angiographic interpretation in guiding operative strategy.
Figure 1: This figure illustrates the standard views and targeted coronary segments in a coronary angiography of the left and right coronary arteries.
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