Mohsen Ghassan A, Mohsin Khaja G, Forsberg Michael, Miller Eric, Taniuchi Megumi, Klein Andrew J P
Department of Internal Medicine, St Louis University Hospital, St Louis, Missouri, USA.
J Invasive Cardiol. 2013 Jun;25(6):284-7.
To determine the incidence of angiographically evident coronary artery disease (CAD) of the anomalous left circumflex artery (ALCx).
Due to the acute angulation of its origin from the aorta and its retroaortic course, some have proposed an increase in CAD in these vessels.
We performed a retrospective cohort study of all patients (n = 5205) presenting for left heart catheterization at the St Louis Veterans Affairs hospital from 2006-2012. Quantitative coronary angiography (QCA) was performed by two independent operators for all cases identified as having ALCx (n = 18).
We identified 18 patients (0.346%) with this anomaly. Sixteen of 18 cases (89%) had atherosclerosis involving the ALCx. QCA performed on the ALCx for all 18 patients resulted in a mean stenosis of 61% (range, 10%-100%). Seven out of 18 patients (39%) had obstructive CAD of the ALCx with the majority (n = 6; 86%) also having concomitant obstructive disease in the left anterior descending (LAD) or right coronary artery (RCA). In the 5 cases where the ALCx underwent intervention, the mean diameter stent was 2.25 mm, with a mean length of 15 mm, indicating that these vessels were small in caliber with focal disease. At a mean follow-up of 18 months for all patients, there was 1 non-cardiac death in the non-intervened group, with the 17 remaining patients (94.7%) free of major adverse cardiovascular events (target lesion revascularization, target vessel revascularization, or death).
This study suggests that indeed this most common anomaly appears to be benign in that its unique origin and/or retroaortic course do not increase the occurrence of atherosclerosis relative to the LAD and RCA.
确定左旋支动脉异常（ALCx）的血管造影显示明显冠状动脉疾病（CAD）的发生率。
由于其从主动脉起源处的急性成角及其主动脉后走行，一些人提出这些血管中CAD的发生率增加。
我们对2006年至2012年在圣路易斯退伍军人事务医院进行左心导管插入术的所有患者（n = 5205）进行了一项回顾性队列研究。由两名独立操作人员对所有被确定为有ALCx的病例（n = 18）进行定量冠状动脉造影（QCA）。
我们确定了18例（0.346%）有这种异常的患者。18例中的16例（89%）有累及ALCx的动脉粥样硬化。对所有18例患者的ALCx进行QCA，平均狭窄率为61%（范围为10% - 100%）。18例患者中的7例（39%）有ALCx的阻塞性CAD，大多数（n = 6；86%）在左前降支（LAD）或右冠状动脉（RCA）也有伴随的阻塞性疾病。在ALCx接受干预的5例患者中，支架平均直径为2.25 mm, 平均长度为15 mm，表明这些血管管径小且有局灶性病变。所有患者平均随访18个月，未干预组有1例非心脏死亡，其余17例患者（94.7%）无主要不良心血管事件（靶病变血运重建、靶血管血运重建或死亡）。
本研究表明，实际上这种最常见的异常似乎是良性的，因为其独特的起源和/或主动脉后走行相对于LAD和RCA不会增加动脉粥样硬化的发生率。
