CTICasesFocal Stenosis of Posterior Descending Artery
Imaging findings
Coronary CT angiography and FFR-CT in a left-dominant patient show severe proximal right coronary artery narrowing which is hemodynamically insignificant (due to non-dominance). However, a focal, subtle stenosis of the distal posterior descending artery (PDA) is shown to be hemodynamically significant, confirmed by cath.
Key takeaways
The hemodynamic significance of a coronary stenosis depends heavily on dominant anatomy and perfusion territory. Sub-centimeter, distal stenosis in dominant vessels can be hemodynamically significant, whereas anatomically severe narrowing in non-dominant vessels may be physiologically minor.
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