CTICasesDual Left Anterior Descending Artery (Dual LAD) Coronary Variant
Imaging findings
Coronary CT demonstrates a very short proximal LAD that arises from the left main and gives off the circumflex normally but then is tiny before giving off a dominant first septal branch. The septal branch then dives into the septum and emerges distally to supply the remaining LAD territory, producing the appearance of two separate LAD vessels (the short proximal LAD and the dominant septal-turned-LAD). This represents one of the multiple described configurations of dual LAD coronary anatomy.
Key takeaways
Dual LAD is a rare coronary anomaly in which two vessels supply the LAD territory: a short proximal LAD that may terminate after giving off the diagonal and a second vessel (often arising from the first diagonal or a septal branch) that wraps around to supply the distal LAD territory. Multiple classification systems have been proposed with up to 14 types described. The clinical significance is generally benign, but correct identification prevents misinterpretation as a vascular malformation or other anomaly during pre-procedural coronary CT.
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