Percutaneous coronary intervention (PCI) for ostial right coronary artery (RCA) lesions remains challenging and is associated with higher rates of restenosis and target lesion revascularization, even in the contemporary drug-eluting stent era. These unfavorable outcomes are largely attributable to the unique anatomical and histological characteristics of the aorto-ostial junction, including severe calcification, limited vessel compliance, and hinge motion. Intravascular ultrasound (IVUS) studies have identified distinct morphological patterns of ostial RCA lesions, including isolated ostial lesions, diffuse atherosclerotic disease without calcified nodules, and lesions characterized by calcified nodules, which are associated with poorer clinical outcomes. Optimal management of ostial RCA lesions requires careful lesion assessment and tailored therapeutic strategies. For de novo lesions, adequate lesion preparation using high-pressure/scoring balloon dilation, rotational atherectomy (RA), or intravascular lithotripsy is essential to achieve optimal stent expansion. Precise ostial stent placement and intravascular imaging-guided optimization are critical procedural components, and drug-coated balloon (DCB) therapy may be considered in selected cases with a high risk of restenosis. In-stent restenosis (ISR) of the ostial RCA is frequently driven by mechanical factors such as stent underexpansion or fracture. DCBs are the preferred first-line treatment for ISR, while additional lesion modification using high-pressure balloons, RA may be required in cases with significant mechanical constraints. This review summarizes current evidence on the morphology, mechanisms, and contemporary treatment strategies for ostial RCA lesions, with a particular focus on intravascular imaging-guided intervention and practical considerations in clinical practice.

Preterm birth is associated with increased morbidity and mortality, including risk for ischemic heart disease and heart failure in adulthood. While smaller coronary size has been reported in preterm children, this has not been reported for adults. We hypothesized that coronary artery size would be reduced in adults born preterm. Cardiac MRI was performed at 1.5 T. Cardiac structure and function were determined using short axis balanced steady state free precession (bSSFP) cine. Left main (LM), left anterior descending (LAD), and right coronary artery (RCA) area and diameter measures were acquired with 3-dimensional bSSFP coronary magnetic resonance angiography imaging. Young adults born preterm (gestational age: 27.1 ± 2.2 wks) exhibited smaller LM, LAD, and RCA area and diameter, with a clear dose effect of prematurity after adjusting for sex and left ventricular mass. Although females had smaller coronary artery size regardless of birth status, the smaller coronary artery size among preterm-born adults was primarily driven by males with reductions in LM, LAD, and RCA dimensions. In conclusion, we have identified young adults born preterm have smaller coronary artery size, and these findings are highly influenced by sex, with substantial decreases in males born preterm. Young adults born preterm exhibit smaller coronary artery size compared to age-match term-born adults. These reductions in coronary artery dimensions in the preterm adults were most notable in males. Smaller coronary artery diameters have been linked as a potential risk factor for atherosclerosis and increased prevalence of coronary artery disease in certain populations. These findings could contribute to higher risk for coronary artery disease in adults born preterm, and predict a higher ischemic burden in men born preterm.

Abstract Objectives Coronary artery ectasia (CAE) is characterised by an increase in the diameter of a coronary artery of ≥1.5 times its diameter at the adjacent vessel. It is evident that alterations in the extracellular matrix changes contribute to the development of CAE. Lysyl oxidases (LOXs) are copper-dependent monoamine oxidase enzymes that play a crucial role in the regulation of connective tissue. Deficiencies in these enzymes have been linked to vascular changes, consequently leading to cardiovascular diseases. The objective of this study was to assess the association between the LOX -G473A (rs1800449) variation and inflammatory markers in CAE development. Methods The current cross-sectional study includes 88 patients whom CAE was confirmed in one of the coronary arteries by coronary angiography and 75 controls with positive exercise tests and angiographically normal coronary arteries without any typical ischemic symptoms and family history of cardiac diseases. Luminex technology was used to detect inflammatory markers. The fluorescence end-point PCR method was used for genotyping. Results Significantly higher plasma levels of TNF-α, sE-selectin, and hypercholesterolemia were observed in the CAE group (p<0.05). Male gender was found as risk factor for CAE. Although the genotype and allele distributions did not showed statistical significance, CAE patients with GA genotype had significantly higher levels of TNF-α and sP-selectin compared to patients with GG genotype. In addition, patients with right coronary artery (RCA) ectasia had higher TNF-α levels than patients with non-RCA ectasia. Conclusions Our findings could suggest that LOX -G473A polymorphism could be associated with the increase in inflammatory markers and CAE development.

Ostial Occlusion of All Epicardial Coronary Arteries: Living off Bypass Grafts.

Aslanger's and de Winter's patterns associated with acute left coronary artery disease: A case report of two patients.

ASSOCIATION OF SITE OF RIGHT CORONARY ARTERY OCCLUSION AND RECOVERY OF COMPLETE HEART BLOCK IN ACUTE INFERIOR WALL MYOCARDIAL INFARCTION UNDERGOING PRIMARY ANGIOPLASTY: THE RECOVER-CHB STUDY.

Pericoronary adipose tissue attenuation (PCATa) on computed tomography angiography reflects coronary artery inflammation and associated with cardiovascular risk beyond atherosclerosis in general patients. We aimed to evaluate the relationships between PCATa and coronary atherosclerosis burden, progression and cardiovascular risk in rheumatoid arthritis (RA). A total of 150 patients in a single-centre observational cohort underwent screening and surveillance coronary imaging 6.9±0.3 years later. PCATa around left anterior descending (LAD), left circumflex (LCx) and right coronary artery (RCA) were measured. Numbers of atherosclerotic segments (disease extent), plaque composition (noncalcified, low-density, mixed or calcified) and absolute volumes (mm3, plaque burden) were computed. Mean (adjusted incidence rate ratio 1.21 [95% confidence interval 1.02-1.27]), LCx (1.20 [1.00-1.43]) and RCA-PCATa (1.22 [1.02-1.46] per standard deviation (SD) increase) associated with total plaque numbers and variably with plaque subtype extent and burden at baseline. Mean and artery-specific PCATa exhibited diverse associations with total, noncalcified, low-density and calcified plaque progression. Using artery-specific PCATa thresholds, mean (adjusted hazards ratio 0.10 [95% CI 0.02-0.56]), LCx (0.11 [95% CI 0.03-0.43]) and RCA-PCATa (0.15 [0.04-0.53] per SD increase) were linked to cardiovascular risk. RCA-PCATa threshold in particular increased risk estimate accuracy (ΔAUC = 0.066 [bias-corrected 95% CI 0.024-0.126], P = 0.005). Mean and artery-specific PCATa associated with the extent, burden and composition of coronary plaque and its progression in RA. Mean, LCx and RCA-PCATa were linked to cardiovascular events, and RCA-PCATa specifically optimized risk estimates beyond atherosclerosis, highlighting its potential utility as a predictive biomarker.

Coronary artery anomalies are uncommon in routine clinical practice, but some variants can have important clinical implications when they compromise coronary blood flow. One such pattern is an anomalous origin of the right coronary artery (RCA) with an inter-arterial course with deep intramyocardial bridging and transcommissural origin, which is considered a potentially high-risk configuration. We report a 57-year-old man who presented with exertional chest pain and was diagnosed with non–ST elevation myocardial infarction. To better delineate the anatomy, ECG-gated cardiac computed tomography (CT) angiography was performed. CT angiography demonstrated a high transcommissural origin of the RCA above the sinotubular junction. The RCA then coursed between the aortic root and the right ventricular outflow tract, consistent with an inter-arterial trajectory, with evidence of luminal compression along this segment. A short intramyocardial (myocardial bridging) segment measuring approximately 1.28 cm was also identified, contributing to dynamic narrowing. No significant atherosclerotic stenosis was noted in the other coronary arteries. The coexistence of a high take-off RCA, malignant inter-arterial course, and myocardial bridging likely contributed to the patient’s ischaemic symptoms. This case underscores the value of cardiac CT angiography in clearly defining complex coronary anatomy and supporting appropriate clinical decision-making.

Background/Objectives: Coronary computed tomography angiography (CCTA) is a modern method for assessing the total burden of atherosclerotic lesions. The perivascular fat attenuation index (PFAI) is a reliable predictor of major adverse cardiovascular events (MACE). Radiomics extracts substantially more information from images than visual assessment by radiologists. However, the relationships between quantitative parameters of coronary atherosclerosis, the PFAI, and radiomic features of pericoronary adipose tissue (PCAT) in patients with coronary artery disease (CAD) remain unclear. The study aimed to evaluate the associations between PCAT characteristics, including radiomic features, and quantitative parameters of coronary atherosclerosis in stable CAD patients. Methods: The study included 79 patients with stable CAD who underwent CCTA. The patients were divided into two groups: nonobstructive CAD (NOCAD, stenosis < 50%; n = 61) and obstructive CAD (OCAD, stenosis ≥ 50%; n = 18). The CCTA data were analyzed to quantify coronary atherosclerosis parameters (plaque volume and burden), the PFAI, PCAT volume, and radiomic features of PCAT in the proximal segments of major coronary arteries. Results: The study included 79 patients: NOCAD group = 61 patients (age 57.00 (50.00-65.00) years) and OCAD group = 18 patients (age 60.5 (55.75-65.75) years). The OCAD patients exhibited higher plaque volume and burden across all components. No significant between-group differences were observed in PFAI or PCAT volume for any vessel. However, 50% (46/92) of PCAT radiomic features in the proximal right coronary artery (RCA) differed significantly between groups, 42 of which were textural. The PFAI correlated most strongly with soft tissue (ST) plaque volume (ρ = -0.22), and burden (ρ = -0.21) of the soft tissue component of plaques (p < 0.001). The PCAT volume significantly correlated (p < 0.001) with plaque volume (ρ = 0.30) and with individual components-soft tissue (ρ = 0.30), fibrous-fatty (ρ = 0.27), fibrous (ρ = 0.30), calcified (ρ = 0.22), and non-calcified (ρ = 0.30)-as well as with the burden of the soft tissue component (ρ = 0.26). Conclusions: The radiomic features of RCA PCAT differed significantly between the NOCAD and OCAD groups. Quantitative coronary atherosclerosis parameters showed significant associations with the PCAT radiomic features in CAD patients, potentially serving as independent predictors of the MACE risk. In contrast, the PFAI values did not differ between groups and neither PFAI nor PCAT volume associated with atherosclerosis parameters.

The fat attenuation index (FAI) derived from coronary computed tomography angiography (CTA) is an emerging imaging biomarker of perivascular inflammation. Coronary flow reserve (CFR), assessed by phase-contrast (PC) cine cardiac magnetic resonance (CMR) of the coronary sinus, reflects coronary microvascular function. Although FAI has been linked to adverse outcomes in coronary artery disease (CAD), its relationship with CFR across different CAD stages is not well defined. We retrospectively evaluated 241 patients (mean age 73.4 ± 10.8 years; 149 men [61.8%]) who underwent both coronary CTA and CMR (122 with known CAD and 119 with suspected CAD). FAI was measured in the proximal left anterior descending (LAD), left circumflex (LCX), and right coronary (RCA) arteries. Impaired CFR was defined as <2.0. Univariable and multivariable logistic regression analyses were performed to identify factors associated with impaired CFR. Impaired CFR was observed in 38 of 122 patients (31.1%) with known CAD and 26 of 119 (21.8%) with suspected CAD. Higher LAD-FAI was associated with impaired CFR in both groups: OR 1.06 (95% CI 1.01-1.11; p = 0.018) in known CAD and OR 1.08 (95% CI 1.02-1.15; p = 0.017) in suspected CAD. Correlation analysis also demonstrated an inverse relationship between LAD-FAI and CFR (p < 0.001), and the strength of association was comparable between the two groups. LAD-FAI was associated with impaired CFR in both suspected and known CAD, with comparable strength of association across the two groups. These findings indicate that perivascular inflammation, reflected by FAI, may relate to coronary microvascular dysfunction in different stages of CAD.

Chronic total occlusion (CTO) in the right coronary artery (RCA) is common in multivessel coronary artery disease. The impact of bypass grafting in the small target vessel (1.0-1.5 mm) of the RCA-CTO on outcomes is unknown. RCA-CTO was treated with either bypass grafting (RCA-bypass group) or non-bypass grafting (non-RCA-bypass group). The study compared the shortand long-term outcomes of patients who underwent coronary artery bypass grafting with or without the bypass grafting located in the small target vessel of the RCA-CTO. A total of 426 patients were enrolled in the present study, including 376 patients in the RCA-bypass group and 50 patients in non-RCA-bypass group. The 30-day all-cause death in the RCA-bypass and non-RCA-bypass groups was 2.39% and 2.0% (P=0.999), respectively. The median follow-up time was 73 months. The long-term major adverse cardiac and cerebrovascular events in the RCA-bypass and non-RCA-bypass groups were 6.91% and 18% (P=0.013), respectively. There was a trend toward a higher rate of long-term freedom from major adverse cardiac and cardiovascular events within the RCA-bypass group (log-rank P=0.088). The bypass grafting located in the small target vessel of the RCA-CTO did not affect the short-term outcomes, but it was associated with a reduced risk of long-term major adverse cardiac and cardiovascular events in patients who underwent coronary artery bypass grafting.

Numerous previous studies have examined the relationship between the fat attenuation index (FAI) and major adverse cardiovascular events (MACE), reporting inconsistent findings. We conducted a systematic search of four databases (PubMed, Embase, Web of Science, and the Cochrane Library) for cohort, case-control, and cross-sectional studies evaluating the association between FAI and MACE incidence. The outcomes were defined as the correlations between MACE and FAI, including total FAI, FAI of the right coronary artery (RCA), FAI of the left circumflex coronary artery (LCX), and FAI of the left anterior descending (LAD) artery. FAI was analyzed both as a continuous and categorical indicator. Two researchers determined the final inclusion of the literature based on the inclusion and exclusion criteria and completed the data extraction. Study quality was assessed using the Newcastle-Ottawa Scale (NOS). RevMan 5.4 was used to conduct heterogeneity tests, perform statistical pooling, and generate forest plots. Hazard ratios (HRs) were used to estimate the association between FAI and MACE risk. STATA16.0 (StataCorp LLC, College Station, TX, USA) was used to generate funnel plots, and the Egger test was applied to evaluate publication bias. A total of 22 studies involving 10,224 participants were included: 17 cohort studies, 1 cross-sectional study, and 4 case-control studies. The meta-analysis results suggested that there was a significant correlation between MACE and total FAI (FAI as a categorical variable: HR = 2.77, 95% confidence interval (CI) = 2.22-3.46; p < 0.00001; FAI as a continuous variable: HR = 1.15, 95% CI = 1.05-1.26; p = 0.003). There was also a significant association between MACE risk and FAI for the RCA (FAI as a categorical variable: HR = 2.10, 95% CI = 1.58-2.79; p < 0.00001; FAI as a continuous variable: HR = 1.06, 95% CI = 1.04-1.08; p < 0.00001), a significant correlation between the risk of MACE and FAI for the LAD (FAI as a categorical variable: HR = 2.76, 95% CI = 1.93-3.97; p < 0.00001; FAI as a continuous variable: HR = 1.09, 95% CI = 1.06-1.11; p < 0.00001), a significant correlation between the risk of MACE and FAI for the LCX branch (FAI as a categorical variable: HR = 2.68, 95% CI = 1.24-5.80; p = 0.01; FAI as a continuous variable: HR = 1.07, 95% CI = 1.05-1.10; p < 0.00001). Meanwhile, individuals with elevated FAI levels had a significantly increased risk of developing MACE. The results of this meta-analysis show a significant association between FAI and MACE. Higher FAI values are associated with significantly higher risks of MACE. These results suggest that FAI may serve as an imaging indicator for predicting the risk of MACE. CRD420250652674, https://www.crd.york.ac.uk/PROSPERO/view/CRD420250652674.

26-CCC-14600-ACC MINIMALLY INVASIVE SURGERY FOR ANOMALOUS ORIGIN OF THE RIGHT CORONARY ARTERY

26-CCC-15753-ACC IMPLEMENTATION OF JAVELIN SHOCKWAVE IVL TREATMENT FOR LESION PREPARATION OF HEAVILY CALCIFIED RIGHT CORONARY ARTERY IN INFERIOR STEMI

26-CCC-17844-ACC CONGENITAL ABSENCE OF THE RIGHT CORONARY ARTERY IN A PATIENT WITH TETRALOGY OF FALLOT

RedoTAVR coronary obstruction risk in small annuli: A post-TAVR CT study.

26-CCC-12256-ACC RIGHT CORONARY ARTERY TO RIGHT ATRIAL CAMERAL FISTULA IN AN ADULT WITH ATRIAL FIBRILLATION DIAGNOSED BY CCTA

26-CCC-17822-ACC ACUTE STEMI MIMIC IN ANOMALOUS RIGHT CORONARY ARTERY: A CASE OF DYNAMIC COMPRESSION

26-CCC-10444-ACC A CASE OF A RIGHT CORONARY ARTERY FISTULA TO THE GREAT CARDIAC VEIN WITH GIANT CORONARY ANEURYSM IN A 74 YEAR OLD

26-CCC-12725-ACC RIGHT CORONARY ARTERY OCCLUSIVE MYOCARDIAL INFARCTION WITH ANOMALOUS LEFT MAIN FROM ITS PROXIMAL PORTION