The usefulness of the lateral projection in the assessment of the right coronary artery during percutaneous transluminal coronary angioplasty

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Abstract
Optimum coronary angiographic definition of lesion morphology and side branch orientation is important during percutaneous transluminal coronary angioplasty (PTCA) to enhance the ease and safety of guidewire passage. This study was performed to compare the efficacy of the lateral (LAT) projection to conventional angiographic views for right coronary artery (RCA) evaluation pre- and post-PTCA. In 45 consecutive patients undergoing PTCA of 56 RCA lesions, the LAT was available to evaluate 40 lesions pre and 44 lesions post-PTCA. Angiographic comparison of the LAT versus standard LAO, LAO cranial, and RAO views were performed by two experienced angiographers with consensus reading. The LAT was the best projection for assessing lesion morphology pre-PTCA in 19/40 (48%) and in 19/44 (43%) post-PTCA, while the LAT was significantly better (P < 0.01) than standard views for assessing side branch orientation (48/56, 86%) and post-PTCA intimal disruption (18/33, 55%). In addition, LAT was the best view for assessing mid RCA lesions 13/21 (62%) pre-PTCA and 12/27 (44%) post-PTCA, while post-PTCA intimal disruption was best detected by LAT in 14/24 (58%). Lesions only recognized in the LAT view occurred in five instances, four involving right ventricular branch ostia and one involving the proximal posterior descending. Thus, the LAT projection appears helpful during PTCA to assess lesion morphology, eccentricity, side branch orientation, and intimal disruption pre- and post-PTCA as an adjunct to conventional views.