Chapter 4. Angiographic Data.

LCA
AP caudal best for perpendicular view of LM. Proximal LAD/CFX good, but branches will overlap. LAO Cranial shows left septals/right diagonals clearly separated, but CFX and its marginals foreshortened and overlapped. LAO angle (>30) should be set to keep LAD parallel to the spine. Cranial also tilts LM down showing LAD/CFX bifurcation. LAO Caudal(spider view) LM foreshortened, LAD/CFX bifurcation. CFX prox and mid clear along with OM origins. LAD also considered foreshortened. RAO Caudal also shows LM bifurcation, but perpendicular to LAO cranial image. CFX, OM, Ramus, pLAD are seen clearly. 1 of 2 best views for CFX. LAD proximal/distal clear, but mid obscured by overlapping diagonals. RAO Cranial shows mid and distal diagonal origins off LAD along with any bifurcations. Diagonal branches will be projected upward. LAD/CFX overlapping. OMs may overall and CFX foreshortened, but PL branches look good.

RCA
LAO Cranial shows origin, entire mid, and PDA bifurcation (crux). Cranial reduces PDA foreshortening, but PDA and PLs slightly foreshortened. RAO caudal/cranial usually not necessary. Mid RCA, length of PDA and PLs. Upward Septals feeding LAD via collaterals. PLs may overlap needing a cranial view. AP cranial RCA origin, mid foreshortened. Best view for PDA, PL, and collateralized LAD.

GRAFTS
Need multiple views. Important to show aortic origin, body, and distal runoff. Target grafts after standard LCA/RCA shots. RCA: LAOcranial, RAO, APcranial. LAD (or LIMA) lateral, RAOcranial, LAO cranial, AP (lateral best for LAD insertion point). CFX (or OMs): LAO/RAO caudal. DIAGONALS: LAO/RAO cranial.