The Proximal Left Anterior Descending Coronary Artery Tortuosity and Angle Associated with Severe Proximal Left Anterior Descending Coronary Artery Stenosis

Abstract We aimed to describe two factors (coronary artery tortuosity and bifurcation angle) as one descriptor for the evaluation of proximal left anterior descending coronary artery (LAD) disease. We reviewed the medical records of 133 consecutive patients who underwent computed tomography angiography (CTA) for angina symptoms in November 2019 and January 2020. The patients were divided into two groups according to the presence of significant LAD stenosis on CTA (defined as LAD stenosis > 50%). The straight length of the vessel was measured using the central luminal line of the flow path, and, calculated using proprietary algorithms in TeraRecon software. We used three-dimensional volume rendering and two-dimensional axial images to measure the left main coronary artery (LM)-LAD angles. In the univariate analysis, there were significant differences in the linear distance between the endpoints of the 20mm actual curve of the LAD (d20), cosine value for LM-LAD angle (cosθ) < 0.8, age, presence of hypertension or diabetes, and number of pack years. However, in the multivariate analysis, the cosθ multiplied by the d20 (d20*cosθ) < 15.5, presence of hypertension and number of pack years were predictors of significant proximal LAD stenosis. In conclusion, d20*cosθ might be useful as a predictor of proximal LAD stenosis.