Circulation, Vol 62, 1188-1196, Copyright © 1980 by American Heart Association
W Rafflenbeul, F Urthaler, P Lichtlen and TN James
Coronary artery stenoses that limit blood flow below demand are considered
critical. In this comparative study we investigated whether the same degree
of stenosis in either the proximal third of the right coronary artery (RCA)
or the proximal third of the left anterior descending artery (LAD) causes
critical flow reduction. Lesions were quantified from 35-mm cinefilms in
multiple projections using a vernier caliper. These morphometric
measurements were correlated with various manifestations of critical flow
reduction, such as angina pectoris, development of collateral vessels and
segmental wall motion abnormalities. In 13 patients with anginal pain and
isolated RCA stenosis, the mean degree of obstruction was 63% area
stenosis, which was significantly lower (p < 0.05) than that measured in
17 symptomatic patients who had isolated obstructions of the LAD (77% area
stenosis). In patients with an identical degree of obstruction (78%) in
either the LAD or RCA, collateral vessels were angiographically
demonstrable in 53% of the RCA stenoses but in only 29% of the LAD
stenoses. Furthermore, when the stenoses were less than 63% in the RCA and
LAD, regional wall motion abnormalities were more frequently (p < 0.05)
associated with RCA than with LAD stenoses. These observations indicate
that a significantly smaller percent area of stenosis is critical in the
RCA than in the LAD.
ARTICLES
Quantitative difference in "critical" stenosis between right and left coronary artery in man
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