Right coronary artery

Coronary Angiography

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Lesion Complexity

ACC/AHA Lesion-Specific Classification of the Primary Target Stenosis

Preprocedural Lesion Morphology

Eccentricity
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Ulceration
Intimal Flap
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Length
Ostial location
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Degenerated SVG
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Coronary Artery Thrombus

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TIMI Thrombus Grade 6

Lesion Morphology

Quantitative Coronary Angiography
Definitions of Preprocedural Lesion Morphology
Irregular Lesion
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Arterial Foreshortening
Infarct Related Artery
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Degenerated SVG
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Left ventriculography

Technique
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:  Rim Halaby, M.D. [2]; Hilda Mahmoudi M.D., M.P.H.[3]

Synonyms and keywords: RCA

## Overview

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The right coronary artery (RCA) originates above the right cusp of the aortic valve. It travels down the right atrioventricular groove, towards the crux of the heart. In addition to supplying blood to the right ventricle (RV), the RCA supplies 25% to 35% of the left ventricle (LV).

## Branches

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The main branches of the RCA are the following:

#### Conus artery

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The right coronary artery branches into the conus artery at the origin of the RCA.

#### SA branch

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The RCA supplies the SA nodal artery in 60% of patients. The other 40% of the time, the SA nodal artery is supplied by the left circumflex artery.

#### Acute marginal artery

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It supplies the right ventricular wall.

#### Posterior descending artery

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* In 85% of patients, the RCA gives off the posterior descending artery (PDA). In the other 15% of cases, the PDA is given off by the left circumflex artery.
* It supplies the inferior wall, posterior interventricular septum and posteromedial papillary muscle.[1]

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Shown below is an image depicting the right coronary artery and its different segments. The RCA has a C shape appearance and divides into 10 segments.

R1= Proximal right coronary artery; R2= Mid right coronary artery; R3= Distal right coronary artery; R4= Right posterolateral artery; A1, A2, A3= Acute marginal arteries; RD= Right posterior descending artery; RI= Right inferior artery; RP= Right posterior artery. For a full description of the labels, refer to the table at bottom of the page.

### Right Coronary Artery Anatomic Classification Scheme

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In order to objectively characterize the location of coronary obstructions, the right coronary artery segments can be categorized using an anatomic scheme. Shown below is an anatomic classification scheme developed by the PERFUSE Study Group listing all the 10 segments of the RCA in terms of corresponding numbers, labels, locations and anatomic descriptions.

Segment number | Segment label | Segment location | Segment description

|
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01 | R1 | Proximal right coronary artery | Extends from the ostium of the right coronary artery to the first of the three longest acute marginal branches.
02 | R2 | Mid right coronary artery | Extends from the origin of the first acute marginal branch to the origin of the third acute marginal branch.
03 | R3 | Distal right coronary artery | Extends from the origin of the third acute marginal to the origin of the posterior descending artery.
04 | R4 | Right posterolateral artery | This is the distal continuation of the right coronary artery after the origin of the posterior descending artery. It often has an inverted U shape as described by James and the AV nodal branch originates from this artery. It carries blood to the right posterior and right inferior arteries in large right dominant anatomy, to just the right inferior branch in small right dominant anatomy, and it is not present in left or balanced dominant systems.
05, 06, 07 | A1, A2, A3 | Acute marginal arteries | The longest three arteries arising from the right coronary artery to supply the right ventricular wall, numbered from proximal to distal.
08 | RD | Right posterior descending artery | In all but left dominant systems, this vessel runs in the posterior interventricular groove and supplies septal perforator branches. When present, it is one of the three longest branches on the inferior wall of the heart.
09 | RI | Right inferior artery | Arises from the fourth segment of the right coronary artery and supplies the inferior wall. In small right dominant anatomy, it is the distal most branch arising from the right coronary artery, while in large right dominant anatomy it arises proximal to the origin of the right posterior artery. When present, it is one of the three longest branches on the inferior wall of the heart.
10 | RP | Right posterior artery | Distal most branch to arise from the right coronary artery, but present only in large right dominant systems. When present, it is one of the three longest branches on the inferior wall of the heart.

## Coronary Angiography of the RCA

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Click here for the standard angiographic views of the right coronary artery.

## Additional Images

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*   * Base of ventricles exposed by removal of the atria.

* The arch of the aorta, and its branches.

* Plan of the branches.

* Diagram of a myocardial infarction.

* Aorta and coronary arteries at autopsy. The proximal portion of the RCA and its ostium can be seen at the lower left.

## References

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1. ↑ Morton DA, Foreman KB, Albertine KH. Chapter 4. Heart. In: Morton DA, Foreman KB, Albertine KH, eds. The Big Picture: Gross Anatomy. New York: McGraw-Hill; 2011.

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Coronary Angiography

Coronary Anatomy|

Normal coronary anatomy • Anomalous origins of coronary arteries
(Left coronary artery • Right coronary artery) • Congenital abnormalities of coronary arteries • Coronary artery segments • Cinefilm frame speed • Coronary artery dominance (Left dominance • Right dominance • Co-dominance)

TIMI Flow Grade|

TIMI flow grade 0 • TIMI flow grade 1 • TIMI flow grade 2 • TIMI flow grade 3

TIMI Frame Count|

TFC for SVG • TIMI Myocardial Frame Count • Washout TIMI Frame Count

TIMI Myocardial Perfusion Grade|

TIMI MPG 0 • TIMI MPG 1 • TIMI MPG 2 • TIMI MPG 3

Thrombus Grading|

Thrombus Grade 0 • Thrombus Grade 1 • Thrombus Grade 2 • Thrombus Grade 3 • Thrombus Grade 4 • Thrombus Grade 5 • Thrombus Grade 6

Lesion Complexity|

Type A • Type B1 • Type B2 • Type C

Dissection Classification|

Type A • Type B • Type C • Type D • Type E • Type F

Coronary Collaterals|

Grade 0 • Grade 1 • Grade 2 • Grade 3 • Rentrop and Cohen’s Collateral Classification

Lesion Morphology|

Myocardial bridge •Definitions of Preprocedural Lesion Morphology • Luminal irregularities • Disease extent • Arterial foreshortening • Infarct related artery (Culprit lesion) • Reocclusion • Restenosis • Degenerated saphenous vein graft • Coronary artery fistula

Angiographic complications|

Distal embolization • Coronary spasm • Abrupt closure • Side branch loss • Slow flow • No-reflow • Pulsatile flow • Flow deceleration • Ectasia • Intimal flap • Staining •

Performing Coronary Angiography|

Patient preparation • Catheter selection • Standard angiographic views • High risk groups • Patients with special need • Access site closure (Manual compression • Assisted compression • Closure devices) •

Quantitative Coronary Angiography (QCA)|

Minimal lumen diameter • Percent stenosis • Reference diameter • Lesion length • Residual stenosis • Average reference segment diameter • Plaque area • Plaque volume •

Contrast Media|

High-osmolar contrast media • Iso-osmolar contrast media • Low-osmolar contrast media

Left Ventriculography & Aortography|

Ejection fraction • Aortography • Quantitative Left Ventricular Analysis (LAO projection • RAO projection • LVA) • Left Ventricular Wall Motion Analysis (Normokinesia • Hypokinesia • Akinesia • Dyskinesia • Aneurysm) • Evaluation of mitral regurgitation • Evaluation of aortic regurgitation

Right Heart Catheterization|

Pressure waveforms (Right atrial pressure • Rirght ventricular pressure • Pulmonary artery pressure • Pulmonary artery wedge-pressure) • Endomyocardial biopsy

Complications|

Access site complications • Dumping • Contrast hypersensitivity • Contrast induced nephropathy • Hypotension • Hypertension • Dissection • Vessel perforation • Acute myocardial infarction • Ventricular fibrillation • Cardiac arrest • Stroke • ASD • VSD • Pulmonary emboli • Myocardial rupture • Peripheral arterial emboli • Radiation injury

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