Difference in the Localisation of Coronary Artery Disease Between the Left and Right Coronary Artery System

REVIEW, February 2011, VOL I ISSUE III, ISSN 2042-4884
10.5083/ejcm.20424884.31 , Cite or Link Using DOI
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George D. Giannoglou, MD, PhD, Antonios P. Antoniadis, MD, MSc, Konstantinos C. Koskinas, MD, MSc & Yiannis S. Chatzizisis, MD, PhD

ABSTRACT

Differences in the prevalence, extent and severity of atherosclerotic lesions in the left coronary artery (LCA) versus the right coronary artery (RCA) have come to the fore, as they may influence the clinical presentation, complications and subsequent management of coronary artery disease. Data from descriptive epidemiological studies suggest a higher susceptibility of the LCA for athero-
sclerosis in comparison to the RCA. Altered haemodynamics, as a result of the different forces exerted in LCA and RCA during the cardiac cycle, affect blood flow properties and favour the development of regions with low or oscillatory endothelial shear stress in the LCA, thereby promoting atherogenesis. Increased wall stress in the LCA, as well as the complex three dimensional geometric configuration of the coronary arteries in combination with the divergent dynamic structural alterations they undergo during the cardiac cycle may also contribute to the above disparity in atherosclerosis susceptibility between RCA and LCA. Further analytical research in the above factors is warranted to elucidate the precise pathoplysiologic mechanisms of coronary atherosclerosis.

INTRODUCTION

Although atherosclerosis is a systemic disease affecting a variety of vascular beds in the body, the distribution of obstructive lesions is rather heterogeneous and asymmetric. Specific regions in the vasculature have been well recognised as more susceptible to the development of atheromatous plaques (brancing points, bifurcations, inner side of curvatures) probably owing to the local effect of flow-related haemodynamic forces (1-3).

The unique structural configuration of the human coronary arterial system presents considerable anatomic and physiologic differences between the left (LCA) and right (RCA) coronary artery. The effect of these differences in the prevalence, extent and severity of coronary lesions in the LCA versus RCA has come to the fore, as this may affect the clinical presentation and subsequent management of atherosclerotic coronary artery disease.

The purpose of the present review is to summarise current evidence regarding differences in the localisation of coronary artery disease between LCA and RCA, describe their clinical implications, and provide a possible pathophysiologic explanation in relation to the flow-related risk factors for atherosclerosis.