2Department of Cardiology, Kayseri City Training and Research Hospital, Kayseri, Türkiye
Abstract
Objective: In this single-center, tertiary-care coronary CT angiography (CCTA) series, we aimed to report the prevalence of coronary origin anomalies and describe the characteristics of their proximal course.
Materials and Methods: This retrospective study included 3,181 consecutive CCTA examinations performed between January 1, 2020, and June 30, 2025. All scans were acquired using a 64-slice multidetector CT system (SOMATOM Definition AS+, Siemens Healthineers) with retrospective ECG gating. Two radiologists reviewed the studies, and examinations with suspected coronary origin anomalies were re-evaluated by consensus. Anomalies were classified according to the Angelini framework, and the proximal course was categorized as interarterial, retroaortic, transseptal/intraseptal, or prepulmonic.
Results: Coronary artery origin anomalies were identified in 41 of 3,181 patients (1.29%). The largest subgroup was opposite-sinus origin (n = 24, 0.76%), which included the right coronary artery (RCA) originating from the left sinus (n = 12, 0.38%), the left circumflex artery (LCX) originating from the right coronary sinus (n = 8, 0.26%), and the left main coronary artery (LMCA) originating from the right coronary sinus (n = 4, 0.13%). An absent LMCA configuration—defined by separate left-sinus ostia for the left anterior descending artery (LAD) and LCX—was identified in 5 patients (0.16%). Single coronary artery anatomy was observed in 3 cases (0.09%), all of which had a common origin from the right coronary sinus. In one case (0.03%), the RCA arose from the noncoronary sinus. High take-off coronary artery origins were observed in 8 patients (0.26%). Regarding the course patterns, interarterial courses were observed in 20 patients, retroaortic courses in 10, and prepulmonic courses in 2. The interarterial LAD and LCX cases also demonstrated a transseptal/intraseptal segment.
Conclusion: CCTA reliably delineates coronary ostial origin and proximal trajectory, supporting a comprehensive anatomic assessment of suspected congenital coronary variants.