Difference in the Localisation of Coronary Artery Disease Between the Left and Right Coronary Artery System

Differences in the prevalence, extent and severity of atherosclerotic lesions in the left coronary artery (LCA) versus the right coronary artery (RCA) have come to the fore, as they may influence the clinical presentation, complications and subsequent management of coronary artery disease. Data from descriptive epidemiological studies suggest a higher susceptibility of the LCA for athero- sclerosis in comparison to the RCA. Altered haemodynamics, as a result of the different forces exerted in LCA and RCA during the cardiac cycle, affect blood flow properties and favour the development of regions with low or oscillatory endothelial shear stress in the LCA, thereby promoting atherogenesis. Increased wall stress in the LCA, as well as the complex three dimensional geometric configuration of the coronary arteries in combination with the divergent dynamic structural alterations they undergo during the cardiac cycle may also contribute to the above disparity in atherosclerosis susceptibility between RCA and LCA. Further analytical research in the above factors is warranted to elucidate the precise pathoplysiologic mechanisms of coronary atherosclerosis.