Dual left anterior descending coronary artery

Last revised by Kapisoor Singh on 30 Apr 2023

Citation, DOI, disclosures and article data

Citation:

Weerakkody Y, Singh K, Feger J, et al. Dual left anterior descending coronary artery. Reference article, Radiopaedia.org (Accessed on 19 Apr 2024) https://doi.org/10.53347/rID-69986

DOI:

https://doi.org/10.53347/rID-69986

Permalink:

https://radiopaedia.org/articles/69986

rID:

69986

Article created:

29 Jul 2019, Yuranga Weerakkody ◉

Disclosures:

At the time the article was created Yuranga Weerakkody had no recorded disclosures.

View Yuranga Weerakkody's current disclosures

Last revised:

30 Apr 2023, Kapisoor Singh

Disclosures:

At the time the article was last revised Kapisoor Singh had no financial relationships to ineligible companies to disclose.

View Kapisoor Singh's current disclosures

Revisions:

6 times, by 4 contributors - see full revision history and disclosures

Systems:

Cardiac

Synonyms:

Dual LAD
Duplicated left anterior descending coronary artery
Duplication of left anterior descending coronary artery
Duplicated LAD
Dual left anterior descending coronary arteries

A dual left anterior descending coronary arteries are a group of rare variants of the left anterior descending artery. Almost all dual variants have short and long LAD branches.

Subtypes

Several (up to 11) subtypes have been described including the 4 initial types originally described by Spindola-Franco and colleagues ¹.

These include

type I:
- considered commonest
- both left-main and LAD proper present
- short LAD originates from the LAD proper and terminates in the proximal anterior interventricular sulcus
- long LAD originates from the LAD proper, courses on the LV side of the proximal anterior interventricular sulcus and reenters the distal anterior interventricular sulcus
type II:
- both left-main and LAD proper present
- short LAD originates from the LAD proper and terminates in the proximal anterior interventricular sulcus
- long LAD originates from the LAD proper, courses on the RV side of the proximal anterior interventricular sulcus and reenters the distal anterior interventricular sulcus
type III:
- both left-main and LAD proper present
- short LAD originates from the LAD proper and terminates in the proximal anterior interventricular sulcus
- long LAD originates from the LAD proper, follows an intramyocardial course in the septum proximally, emerges epicardially in the distal anterior interventricular sulcus (or does not emerge in the anterior interventricular sulcus and terminated, intramyocardially)
type IV:
- left-main present but LAD proper absent
- short LAD originates from the LAD proper and terminates in the proximal anterior interventricular sulcus
- long LAD originates from the proximal right coronary artery (RCA), follows an anomalous pre-pulmonic course anterior to the RVOT, and enters the distal anterior interventricular sulcus
type V:
- both left-main and LAD proper absent
- short LAD originates from the left coronary sulcus, terminates in the proximal anterior interventricular sulcus
- long LAD originates from the proximal right coronary sulcus, follows an anomalous intramyocardial course within the septal crest, emerges epicardially, and enters the distal anterior interventricular sulcus
type VI:
- left-main present but LAD proper absent
- short LAD originates from the left main and terminates in the proximal anterior interventricular sulcus
- long LAD originates from proximal RCA, follows an anomalous course between the RVOT and the aortic root, and enters the distal anterior interventricular sulcus
type VII:
- both left-main and LAD proper present
- left-main originates from the right coronary sulcus and shows an inter-arterial malignant course
- short LAD originates from the LAD proper, terminates in the proximal anterior interventricular sulcus
- long LAD originates from the LAD proper, courses on the LV side of the proximal anterior interventricular sulcus, and reenters the distal anterior interventricular sulcus
type VIII:
- left-main present but LAD proper absent
- left-main originates from the right coronary sulcus and shows a retro-aortic course
- short LAD originates from the left main and terminates in the proximal anterior interventricular sulcus
- long LAD originates from the mid-RCA, courses inferior wall surface of the RV, then turns around the apex, and reaches the distal anterior interventricular sulcus
type IX: (triple LAD)
- both left-main and LAD proper present
- short LAD originates from the LAD proper, terminates in the mid-anterior interventricular sulcus
- long LAD originates from the LAD proper, courses on the LV side of the mid anterior interventricular sulcus, reenters the distal anterior interventricular sulcus and terminates before reaching the apex
type X: ⁶
- long LAD and right coronary artery (RCA) originating from the right coronary sinus with different ostia
- short LAD originates from the left main coronary artery (LMCA) and terminates in the proximal anterior interventricular sulcus.
type XI: ⁷
- short and long LAD arteries share a common ostium with the right coronary artery from the right coronary sinus ⁶